Bolger Jarlath C, Lau Harry, Yeung Jonathan C, Darling Gail E
Division of Thoracic Surgery, University Health Network, Toronto, ON, Canada.
Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
Dis Esophagus. 2023 Feb 24;36(3). doi: 10.1093/dote/doac061.
Pyloroplasty or pyloromyotomy is often undertaken during esophagectomy to aid gastric emptying postoperatively. Minimally invasive esophagectomy (MIE) frequently omits a pyloric procedure. The impact on perioperative outcomes and the need for subsequent interventions is unclear. This study assesses the requirements for endoscopic balloon dilation of the pylorus (EPD) following MIE. Patients undergoing MIE from 2016 to 2020 were reviewed. Patients undergoing open resection, or an intraoperative pyloric procedure were excluded. Demographic, clinical and pathological data were reviewed. Univariable and multivariable analysis were performed as appropriate. In total, 171 patients underwent MIE. There were no differences in age (median 65 vs. 65 years, P = 0.6), pathological stage (P = 0.10) or ASA status (P = 0.52) between those requiring and not requiring endoscopic pyloric dilation (EPD). Forty-three patients (25%) required EPD, with a total of 71 procedures. Twenty-seven patients (16%) had EPD on their index admission. Seventy-five patients (43%) had a postoperative complication. Higher ASA status was associated with increased requirement for EPD (odds ratio 10.8, P = 0.03). On multivariable analysis, there was no association between the need for a pyloric procedure and overall survival (P = 0.14). Eight patients (5%) required insertion of a feeding jejunostomy in the postoperative period, with no difference between those with or without EPD (P = 0.11). Two patients required subsequent surgical pyloromyotomy for delayed gastric emptying. Although pyloroplasty or pyloromyotomy can safely be excluded during MIE, a quarter of patients will require postoperative EPD procedures. The impact of excluding pyloric procedures on gastric emptying requires further study.
在食管切除术期间常进行幽门成形术或幽门肌切开术，以促进术后胃排空。微创食管切除术（MIE）通常省略幽门手术。其对围手术期结局的影响以及后续干预的必要性尚不清楚。本研究评估了MIE术后幽门内镜球囊扩张术（EPD）的需求。对2016年至2020年接受MIE的患者进行了回顾。排除接受开放切除术或术中进行幽门手术的患者。回顾了人口统计学、临床和病理数据。酌情进行单变量和多变量分析。共有171例患者接受了MIE。需要和不需要内镜下幽门扩张（EPD）的患者在年龄（中位数65岁对65岁，P = 0.6）、病理分期（P = 0.10）或ASA状态（P = 0.52）方面没有差异。43例患者（25%）需要EPD，共进行了71次手术。27例患者（16%）在首次入院时接受了EPD。75例患者（43%）发生了术后并发症。较高的ASA状态与EPD需求增加相关（比值比10.8，P = 0.03）。多变量分析显示，幽门手术需求与总生存期之间没有关联（P = 0.14）。8例患者（5%）在术后需要插入空肠造口管进行肠内营养，有无EPD的患者之间没有差异（P = 0.11）。2例患者因胃排空延迟需要后续进行手术幽门肌切开术。虽然在MIE期间可以安全地不进行幽门成形术或幽门肌切开术，但四分之一的患者术后需要进行EPD手术。省略幽门手术对胃排空的影响需要进一步研究。
