Seika Philippa, Biebl Matthias, Raakow Jonas, Berndt Nadja, Feldbrügge Linda, Maurer Max Magnus, Dobrindt Eva, Thuss-Patience Peter, Pratschke Johann, Denecke Christian
Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany.
Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
J Clin Med. 2022 Aug 16;11(16):4773. doi: 10.3390/jcm11164773.
(1) Background: Endoscopic vacuum therapy (EVT) has become the mainstay in the treatment of early anastomotic leakage (AL) after esophageal resection. The effect of nRCT on the efficacy of EVT is currently unknown. (2) Methods: Data of 427 consecutive patients undergoing minimally invasive esophagectomy between 2013 and 2022 were analyzed. A total of 26 patients received EVT for AL after esophagectomy between 2010 and 2021. We compared a cohort of 13 patients after treatment with EVT for anastomotic leakage after neoadjuvant radiochemotherapy (nRCT) with a control group of 13 patients after neoadjuvant chemotherapy (nCT) using inverse propensity score weighting to adjust for baseline characteristics between the groups. EVT therapy was assessed regarding patient survival, treatment failure as defined by a change in treatment to stent/operation, duration of treatment, and secondary complications. Statistical analysis was performed using linear regression analysis. (3) Results: Time to EVT after initial tumor resection did not vary between the groups. The duration of EVT was longer in patients after nRCT (14.69 days vs. 20.85 days, = 0.002) with significantly more interventions (4.38 vs. 6.85, = 0.001). The success rate of EVT did not differ between the two groups (nCT = 8 (61.54%) vs. nCT = 5 (38.46%), = 0.628). The rate of operative revision did not vary between the groups. Importantly, no mortality was reported within 30 days and 90 days in both groups. (4) Conclusions: EVT is a valuable tool for the management of AL after esophageal resection in patients after nRCT. While the success rates were comparable, EVT was associated with a significantly longer treatment duration. Anastomotic leakages after nRCT often require prolonged and multimodal treatment strategies while innovative strategies such as prophylactic endoVAC placement or use of a VAC-Stent may be considered.
(1) 背景：内镜下真空治疗（EVT）已成为食管切除术后早期吻合口漏（AL）治疗的主要手段。目前，新辅助放化疗（nRCT）对EVT疗效的影响尚不清楚。(2) 方法：分析了2013年至2022年间连续427例行微创食管切除术患者的数据。2010年至2021年间，共有26例食管切除术后发生AL的患者接受了EVT治疗。我们使用逆倾向评分加权法对两组之间的基线特征进行调整，比较了13例新辅助放化疗（nRCT）后接受EVT治疗吻合口漏的患者与13例新辅助化疗（nCT）后患者组成的对照组。对EVT治疗的评估包括患者生存率、定义为改为支架/手术治疗的治疗失败情况、治疗持续时间和继发性并发症。使用线性回归分析进行统计分析。(3) 结果：初始肿瘤切除后至接受EVT的时间在两组之间无差异。nRCT后患者的EVT持续时间更长（14.69天对20.85天，P = 0.002），干预次数显著更多（4.38次对6.85次，P = 0.001）。两组之间EVT的成功率无差异（nCT组为8例（61.54%）对nRCT组为5例（38.46%），P = 0.628）。手术修正率在两组之间无差异。重要的是，两组在30天和90天内均未报告死亡病例。(4) 结论：对于nRCT后食管切除术后AL的管理，EVT是一种有价值的工具。虽然成功率相当，但EVT的治疗持续时间显著更长。nRCT后的吻合口漏通常需要延长和多模式治疗策略，同时可考虑采用预防性放置内镜下真空辅助闭合装置（endoVAC）或使用真空支架等创新策略。
