Urabe Masayuki, Ohkura Yu, Haruta Shusuke, Ueno Masaki, Udagawa Harushi
Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
J Chest Surg. 2021 Dec 5;54(6):466-472. doi: 10.5090/jcs.21.047.
Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC.
Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC.
The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy.
As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.
据报道，术中大出血预示着食管癌（EC）手术切除后生存结果不佳。然而，预测胸腔镜食管切除术期间失血量的因素尚未得到充分研究。我们试图确定EC电视辅助胸腔镜手术（VATS）期间失血过多的危险因素。
我们使用简单和多元线性回归模型，对168例连续接受VATS式EC食管切除术患者的临床病理/手术因素与估计失血量之间的关联进行回顾性分析。
中位失血量为225 mL（四分位间距，126 - 380 mL）。腹部剖腹术（p<0.001）、胸导管切除术（p = 0.014）和奇静脉弓离断术（p<0.001）与大量失血显著相关。作为连续变量的体重指数和手术持续时间在简单线性回归中也与失血量呈正相关。多元线性回归分析确定手术持续时间延长（p<0.001）、开放剖腹术入路（p = 0.003）、奇静脉弓离断术（p = 0.005）和高体重指数（p = 0.014）是VATS食管切除术期间出血量增加的独立预测因素。
除体重指数外，手术持续时间、开放剖腹术和奇静脉弓离断术等手术相关因素是VATS式EC食管切除术期间估计失血量的独立预测因素。腹腔镜腹部手术和保留奇静脉弓可能是微创选择，有可能减少术中出血，尽管肿瘤根治性仍是一个重要考虑因素。
