Wu Jessica, Putnam Luke R, Silva Jack P, Houghton Caitlin, Bildzukewicz Nikolai, Lipham John C
Division of Upper GI and General Surgery, Department of Surgery, 12223University of Southern California, Los Angeles, CA, USA.
Am Surg. 2022 Oct;88(10):2499-2507. doi: 10.1177/00031348221101515. Epub 2022 Jun 2.
Although mortality rates after esophagectomy have decreased over the last 30 years, anastomotic leaks still commonly persist and portend significant morbidity. Previous studies have analyzed patient and perio-perative risk factors for leaks, yet data describing the association of leaks and an open or minimally invasive approach are lacking. The purpose of this study was to evaluate the impact of operative approach on leak rates and subsequent management of the leaks.
We queried the Procedure-Targeted National Surgical Quality Improvement Program Database for patients undergoing esophagectomy for cancer in the years from 2016 to 2019. Patient demographics, disease-related information, peri-operative data, and short-term outcomes were reviewed. Multivariable, stepwise logistic regression analysis was performed to investigate factors associated with post-operative anastomotic leaks.
Of the 2696 patients who underwent esophagectomy for cancer, anastomotic leaks occurred in 374 (14%). Based on approach, 13% of open, 14% of laparoscopic, and 18% of robotic cases were complicated by leak ( = .123). Multivariable analysis identified the following significant risk factors for leak: diabetes (OR 1.32, = .047), hypertension (OR 1.32, = .022), and longer operative time (OR 1.61, < .001). The percentage of leaks requiring endoscopic or operative intervention was 75% for open, 79% for laparoscopic, and 54% for robotic cases ( = .004).
Anastomotic leaks after esophagectomy for cancer occur frequently regardless of surgical approach. Furthermore, these leaks are managed differently after an open, laparoscopic, or robotic approach. Robotic esophagectomies complicated by anastomotic leak required less invasive management.
尽管在过去30年里，食管癌切除术后的死亡率有所下降，但吻合口漏仍然普遍存在，并预示着严重的发病率。以往的研究分析了患者及围手术期发生吻合口漏的危险因素，但缺乏描述吻合口漏与开放手术或微创手术方法之间关联的数据。本研究的目的是评估手术方式对吻合口漏发生率及后续漏口处理的影响。
我们查询了2016年至2019年期间接受癌症食管癌切除术患者的以手术为导向的国家外科质量改进计划数据库。回顾了患者的人口统计学资料、疾病相关信息、围手术期数据和短期结局。进行多变量逐步逻辑回归分析，以研究与术后吻合口漏相关的因素。
在2696例接受癌症食管癌切除术的患者中，374例（14%）发生了吻合口漏。根据手术方式，开放手术患者中有13%、腹腔镜手术患者中有14%、机器人手术患者中有18%发生了吻合口漏相关并发症（P = 0.123）。多变量分析确定了以下吻合口漏的显著危险因素：糖尿病（比值比1.32，P = 0.047）、高血压（比值比1.32，P = 0.022）和手术时间较长（比值比1.61，P < 0.001）。开放手术中需要内镜或手术干预的漏口比例为75%，腹腔镜手术为79%，机器人手术为54%（P = 0.004）。
无论采用何种手术方式，癌症食管癌切除术后吻合口漏都很常见。此外，开放手术、腹腔镜手术或机器人手术后对这些漏口的处理方式不同。机器人食管癌切除术后发生吻合口漏的患者所需的侵入性处理较少。
