Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
PLoS One. 2022 Mar 9;17(3):e0265093. doi: 10.1371/journal.pone.0265093. eCollection 2022.
Concomitant liver cirrhosis is a crucial risk factor for major surgeries. However, only few data are available concerning cirrhotic patients requiring esophagectomy for malignant disease.
From a prospectively maintained database of esophageal cancer patients, who underwent curative esophagectomy between 01/2012 and 01/2016, patients with concomitant liver cirrhosis (liver-cirrhotic patients, LCP) were compared to non-liver-cirrhotic patients (NLCP).
Of 170 patients, 14 cirrhotic patients with predominately low MELD scores (≤ 9, 64.3%) were identified. Perioperative outcome was significantly worse for LCP, as proofed by 30-day (57.1% vs. 7.7, p<0.001) and 90-day mortality (64.3% vs. 9.6%, p<0.001), anastomotic leakage rate (64.3 vs. 22.3%, p = 0.002) and sepsis (57.1 vs. 21.5%, p = 0.006). Even after adjustment for age, gender, comorbidities, and surgical approach, LCP revealed higher odds for 30-day and 90-day mortality compared to NLCP. Moreover, 5-year survival analysis showed a significantly poorer long-term outcome of LCP (p = 0.023). For risk stratification, none of the common cirrhosis scores proved prognostic impact, whereas components as Bilirubin (auROC 94.4%), INR (auROC = 90.0%), and preoperative ascites (p = 0.038) correlated significantly with the perioperative outcome.
Curative esophagectomy for cirrhotic patients is associated with a dismal prognosis and should be evaluated critically. While MELD and Child score failed to predict perioperative mortality, Bilirubin and INR proofed excellent prognostic capacity in this cohort.
合并肝硬化是重大手术的关键危险因素。然而，对于需要接受恶性疾病食管切除术的肝硬化患者，仅有少数数据。
从 2012 年 1 月至 2016 年 1 月期间接受根治性食管切除术的食管癌患者的前瞻性数据库中，比较了合并肝硬化的患者（肝硬化患者，LCP）与非肝硬化患者（NLCP）。
在 170 名患者中，确定了 14 名主要具有低 MELD 评分（≤9，64.3%）的肝硬化患者。LCP 的围手术期结果明显较差，30 天（57.1%比 7.7%，p<0.001）和 90 天死亡率（64.3%比 9.6%，p<0.001）、吻合口漏率（64.3%比 22.3%，p=0.002）和脓毒症（57.1%比 21.5%，p=0.006）证实了这一点。即使调整了年龄、性别、合并症和手术方式，LCP 发生 30 天和 90 天死亡率的几率仍高于 NLCP。此外，5 年生存分析显示 LCP 的长期结果明显较差（p=0.023）。对于风险分层，没有任何常见的肝硬化评分证明具有预后影响，而胆红素（auROC 94.4%）、INR（auROC=90.0%）和术前腹水（p=0.038）等成分与围手术期结果显著相关。
肝硬化患者接受根治性食管切除术与预后不良相关，应进行批判性评估。虽然 MELD 和 Child 评分未能预测围手术期死亡率，但胆红素和 INR 在该队列中证明具有出色的预后能力。
