Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany.
Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
Langenbecks Arch Surg. 2021 Sep;406(6):1859-1866. doi: 10.1007/s00423-021-02139-3. Epub 2021 May 15.
Surgery for esophageal cancer is a challenging procedure that is associated with a high rate of complications such as sepsis, nutritional disorders, and anastomotic leakage (AL). The rate of complications following esophageal surgery rises exponentially in the presence of risk factors. This study aims to identify the risk factors for AL following esophageal cancer surgery.
In this retrospective study, we recorded comorbidities, tumor specific factors, nutritional status, and surgical complications of all patients who underwent surgical resections for esophageal cancers between January 2015 and December 2019. The occurrence of potential risk factors for AL was compared between groups with and without AL. We analyzed the categorical variables by Chi-square or Fisher's exact test, and the continuous variable by the Mann-Whitney U test and multivariable regression analyses.
From 92 patients, AL was found in 12 (13%) patients. All cases with AL had hypoproteinemia; a protein level < 5 g/dl was an independent risk factor for AL (p value 0.009). The logistic regression analysis showed a positive correlation between hypoproteinemia and AL (coefficient 1.83, significance 0.01). Additionally, squamous cell carcinoma (SCC) of the esophagus had a positive correlation with AL (coefficient 1.89, significance 0.01).
In our study, hypoproteinemia and SCC were significant risk factors for AL after esophageal cancer surgery. Optimization of preoperative hypoproteinemia using a standardized nutritional protocol is recommended. More research is essential to determine the correlation of SCC with AL.
食管癌手术是一项具有挑战性的操作，其相关并发症发生率较高，如脓毒症、营养障碍和吻合口瘘（AL）。存在危险因素时，食管手术后并发症的发生率呈指数级上升。本研究旨在确定食管癌手术后 AL 的危险因素。
在这项回顾性研究中，我们记录了所有在 2015 年 1 月至 2019 年 12 月期间接受食管癌手术切除的患者的合并症、肿瘤特异性因素、营养状况和手术并发症。比较了有和无 AL 的患者之间潜在 AL 危险因素的发生情况。我们通过卡方检验或 Fisher 精确检验分析分类变量，通过 Mann-Whitney U 检验和多变量回归分析分析连续变量。
在 92 例患者中，有 12 例（13%）发生 AL。所有发生 AL 的患者均有低蛋白血症；蛋白水平<5g/dl 是 AL 的独立危险因素（p 值<0.009）。逻辑回归分析显示低蛋白血症与 AL 呈正相关（系数 1.83，显著性 0.01）。此外，食管鳞状细胞癌（SCC）与 AL 呈正相关（系数 1.89，显著性 0.01）。
在我们的研究中，低蛋白血症和 SCC 是食管癌手术后 AL 的显著危险因素。建议使用标准化营养方案优化术前低蛋白血症。需要进一步研究以确定 SCC 与 AL 的相关性。
