食管癌手术后吻合口漏的危险因素及后果。

Risk Factors and Consequences of Anastomotic Leakage After Esophagectomy for Cancer.

机构信息

Department of Surgery, Amsterdam University Medical Centers, location Amsterdam Medical Center, University of Amsterdam Cancer Center, Amsterdam, the Netherlands.

出版信息

Ann Thorac Surg. 2021 Jul;112(1):255-263. doi: 10.1016/j.athoracsur.2020.08.022. Epub 2020 Oct 17.

DOI:10.1016/j.athoracsur.2020.08.022

PMID:33075324

Abstract

BACKGROUND

Identifying predictors of anastomotic leakage can contribute to prevention of this common complication after esophagectomy. This study identified predictors for anastomotic leakage and assessed the influence of anastomotic leakage on short-term outcomes and long-term survival.

METHODS

A retrospective cohort study was conducted of consecutive patients who underwent esophagectomy in the Amsterdam University Medical Centers, location Amsterdam Medical Center, between 1993 and 2019. Multilevel logistic and Cox regression models were used to assess predictors for anastomotic leakage and survival, and an operation year-level random effects was considered for the unmeasured characteristics at year of operation.

RESULTS

Included were 1539 patients, and anastomotic leakage developed in 288 (19%). Predictors for developing anastomotic leakage after a transthoracic esophagectomy were a higher body mass index and a cervical anastomosis. Diabetes mellitus type 2 and chronic obstructive pulmonary disease were predictors for anastomotic leakage after a transhiatal esophagectomy. Median intensive care unit and hospital stay was longer for patients with anastomotic leakage than for patients without anastomotic leakage (both P < .001 for transthoracic esophagectomy, P = .010 and P < .001, respectively, for transhiatal esophagectomy). A higher percentage of patients with anastomotic leakage died within 30 days (3.8% vs 1.9%, P = .050). However, anastomotic leakage did not significantly influence long-term survival (hazard ratio, 0.994; 95% CI, 0.849-1.176; P = .994).

CONCLUSIONS

Higher body mass index, cervical anastomosis, diabetes mellitus, and chronic obstructive pulmonary disease are predictors for anastomotic leakage after esophagectomy. Anastomotic leakage is associated with worse short-term outcomes, but long-term survival was not influenced. Future studies should focus on patient optimization, accurate patient selection, and development of tools in risk assessment.

摘要

背景

识别吻合口漏的预测因素有助于预防食管癌切除术后这一常见并发症。本研究确定了吻合口漏的预测因素，并评估了吻合口漏对短期结局和长期生存的影响。

方法

对 1993 年至 2019 年期间在阿姆斯特丹大学医学中心阿姆斯特丹医学中心连续接受食管切除术的患者进行了回顾性队列研究。使用多水平逻辑回归和 Cox 回归模型来评估吻合口漏和生存的预测因素，并考虑了手术年份水平的随机效应来解释手术年份未测量的特征。

结果

共纳入 1539 例患者，其中 288 例（19%）发生吻合口漏。经胸食管切除术吻合口漏的预测因素为较高的体重指数和颈部吻合口。2 型糖尿病和慢性阻塞性肺疾病是经食管裂孔食管切除术吻合口漏的预测因素。吻合口漏患者的重症监护病房和住院时间中位数均长于无吻合口漏患者（均 P<0.001，经胸食管切除术；P=0.010 和 P<0.001，经食管裂孔食管切除术）。吻合口漏患者 30 天内死亡的比例更高（3.8%比 1.9%，P=0.050）。然而，吻合口漏并未显著影响长期生存（风险比，0.994；95%CI，0.849-1.176；P=0.994）。