Department of Surgery, University of California, Irvine, Orange, CA, USA.
Am Surg. 2021 Jun;87(6):864-871. doi: 10.1177/0003134820956329. Epub 2020 Nov 24.
The impact of preoperative chemotherapy/radiation on esophageal anastomotic leaks (ALs) and the correlation between AL severity and mortality risk have not been fully elucidated. We hypothesized that lower severity ALs have a similar risk of mortality compared to those without ALs, and preoperative chemotherapy/radiation increases AL risk.
The 2016-2017 American College of Surgeons National Surgical Quality Improvement Program's procedure-targeted esophagectomy database was queried for patients undergoing any esophagectomy for cancer. A multivariable logistic regression analysis was performed for risk of ALs.
From 2042 patients, 280 (13.7%) had ALs. AL patients requiring intervention had increased mortality risk including those requiring reoperation, interventional procedure, and medical therapy ( < .05). AL patients requiring no intervention had similar mortality risk compared to patients without ALs ( > .05). Preoperative chemotherapy/radiation was not predictive of ALs ( > .05).
Preoperative chemotherapy/radiation does not contribute to risk for ALs after esophagectomy. There is a stepwise increased risk of 30-day mortality for ALs requiring increased invasiveness of treatment.
术前化疗/放疗对食管吻合口漏（AL）的影响，以及 AL 严重程度与死亡率风险之间的相关性尚未完全阐明。我们假设，与没有 AL 的患者相比，严重程度较低的 AL 具有相似的死亡风险，且术前化疗/放疗会增加 AL 的风险。
查询了 2016-2017 年美国外科医师学会国家外科质量改进计划针对癌症的食管切除术的目标程序数据库，以确定接受任何食管癌切除术的患者。对 AL 风险进行了多变量逻辑回归分析。
在 2042 例患者中，有 280 例（13.7%）发生了 AL。需要介入治疗的 AL 患者的死亡率风险增加，包括需要再次手术、介入治疗和药物治疗的患者（<0.05）。不需要干预的 AL 患者的死亡率风险与没有 AL 的患者相似（>0.05）。术前化疗/放疗与 AL 无关（>0.05）。
术前化疗/放疗并不会增加食管癌手术后 AL 的风险。需要更具侵入性治疗的 AL 患者，30 天死亡率的风险呈逐步增加。
