Division of Upper Gastrointestinal Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
School of Medical Sciences, Orebro University, Orebro, Sweden.
BMC Surg. 2020 Dec 22;20(1):333. doi: 10.1186/s12893-020-01017-x.
It has been postulated that the hyperadrenergic state caused by surgical trauma is associated with worse outcomes and that β-blockade may improve overall outcome by downregulation of adrenergic activity. Esophageal resection is a surgical procedure with substantial risk for postoperative mortality. There is insufficient data to extrapolate the existing association between preoperative β-blockade and postoperative mortality to esophageal cancer surgery. This study assessed whether preoperative β-blocker therapy affects short-term postoperative mortality for patients undergoing esophageal cancer surgery.
All patients with an esophageal cancer diagnosis that underwent surgical resection with curative intent from 2007 to 2017 were retrospectively identified from the Swedish National Register for Esophagus and Gastric Cancers (NREV). Patients were subdivided into β-blocker exposed and unexposed groups. Propensity score matching was carried out in a 1:1 ratio. The outcome of interest was 90-day postoperative mortality.
A total of 1466 patients met inclusion criteria, of whom 35% (n = 513) were on regular preoperative β-blocker therapy. Patients on β-blockers were significantly older, more comorbid and less fit for surgery based on their ASA score. After propensity score matching, 513 matched pairs were available for analysis. No difference in 90-day mortality was detected between β-blocker exposed and unexposed patients (6.0% vs. 6.6%, p = 0.798).
Preoperative β-blocker therapy is not associated with better short-term survival in patients subjected to curative esophageal tumor resection.
手术创伤引起的交感神经兴奋状态与较差的预后有关，β受体阻滞剂通过下调儿茶酚胺活性可能改善整体预后。食管切除术是一种术后死亡率较高的手术。没有足够的数据将术前β受体阻滞剂与术后死亡率之间的现有关联外推到食管癌手术。本研究评估了术前β受体阻滞剂治疗是否会影响接受食管癌手术患者的短期术后死亡率。
从瑞典食管和胃癌登记处（NREV）回顾性确定了 2007 年至 2017 年间接受根治性手术的所有食管癌诊断患者。患者分为β受体阻滞剂暴露组和未暴露组。按 1:1 比例进行倾向评分匹配。主要结局是 90 天术后死亡率。
共有 1466 名患者符合纳入标准，其中 35%（n=513）接受常规术前β受体阻滞剂治疗。使用β受体阻滞剂的患者年龄较大，合并症较多，根据 ASA 评分，手术适应性较差。进行倾向评分匹配后，共有 513 对匹配对可供分析。暴露组和未暴露组 90 天死亡率无差异（6.0%比 6.6%，p=0.798）。
对于接受根治性食管肿瘤切除术的患者，术前β受体阻滞剂治疗与短期生存率的提高无关。
