Simitian Grigor S, Hall David J, Leverson Glen, Lushaj Entela B, Lewis Erik E, Musgrove Kelsey A, McCarthy Daniel P, Maloney James D
Division of Cardiothoracic Surgery, Department of Surgery, H4/358 Clinical Science Center, 600 Highland Avenue, Madison, WI, United States of America.
Department of Surgery, Clinical Science Center, 600 Highland Avenue, Madison, WI, United States of America.
Surg Open Sci. 2022 Nov 17;11:26-32. doi: 10.1016/j.sopen.2022.11.002. eCollection 2023 Jan.
Anastomotic leak (AL) after minimally invasive esophagectomy (MIE) is a well-described source of morbidity for patients undergoing surgical treatment of esophageal neoplasm. With improved early recognition and endoscopic management techniques, the long-term impact remains unclear.
A retrospective review was conducted of patients who underwent MIE for esophageal neoplasm between January 2015 and June 2021 at a single institution. Cohorts were stratified by development of AL and subsequent management. Baseline demographics, perioperative data, and post-operative outcomes were examined.
During this period, 172 MIEs were performed, with 35 of 172 (20.3%) complicated by an AL. Perioperative factors independently associated with AL were post-operative blood transfusion (leak rate 52.9% versus 16.8%; p = 0.0017), incompleteness of anastomotic rings (75.0% vs 19.1%; p = 0.027), and receiving neoadjuvant therapy (18.5% vs 30.8%; p < 0.0001). Inferior short-term outcomes associated with AL included number of esophageal dilations in the first post-operative year (1.40 vs 0.46, p = 0.0397), discharge disposition to a location other than home (22.9% vs 8.8%, p = 0.012), length of hospital stay (17.7 days vs 9.6 days; p = 0.002), and time until jejunostomy tube removal (134 days vs 79 days; p = 0.0023). There was no significant difference in overall survival between patients with or without an AL at 1 year (79% vs 83%) or 5 years (50% vs 47%) (overall log rank p = 0.758).
In this large single-center series of MIEs, AL was associated with inferior short-term outcomes including hospital length of stay, discharge disposition other than to home, and need for additional endoscopic procedures, without an accompanying impact on 1-year or 5-year survival.
In this large, single-center series of minimally invasive esophagectomies, anastomotic leak was associated with worse short-term outcomes including hospital length of stay, discharge disposition other than to home, and need for additional endoscopic procedures, but was not associated with worse long-term survival. The significant association between neoadjuvant therapy and decreased leak rates is difficult to interpret, given the potential for confounding factors, thus careful attention to modifiable pre- and peri-operative patient factors associated with anastomotic leak is warranted.
微创食管切除术后吻合口漏（AL）是接受食管肿瘤手术治疗患者发病的一个常见原因。随着早期识别和内镜处理技术的改进，其长期影响仍不明确。
对2015年1月至2021年6月在单一机构接受微创食管切除术治疗食管肿瘤的患者进行回顾性研究。根据是否发生吻合口漏及后续处理对队列进行分层。检查基线人口统计学、围手术期数据和术后结果。
在此期间，共进行了172例微创食管切除术，其中172例中有35例（20.3%）发生吻合口漏。与吻合口漏独立相关的围手术期因素包括术后输血（漏率52.9%对16.8%；p = 0.0017）、吻合环不完整（75.0%对19.1%；p = 0.027）和接受新辅助治疗（18.5%对30.8%；p < 0.0001）。与吻合口漏相关的短期不良结局包括术后第一年食管扩张次数（1.40次对0.46次，p = 0.0397）、出院去向非家庭（22.9%对8.8%，p = 0.012）、住院时间（17.7天对9.6天；p = 0.002）以及空肠造瘘管拔除时间（134天对79天；p = 0.0023）。有或无吻合口漏的患者在1年（79%对83%）或5年（50%对47%）时的总生存率无显著差异（总体对数秩检验p = 0.758）。
在这个大型单中心微创食管切除术系列研究中，吻合口漏与包括住院时间、出院去向非家庭以及需要额外内镜操作等较差的短期结局相关，但对1年或5年生存率无伴随影响。
在这个大型单中心微创食管切除术系列研究中，吻合口漏与包括住院时间、出院去向非家庭以及需要额外内镜操作等更差的短期结局相关，但与更差的长期生存率无关。鉴于存在混杂因素的可能性，新辅助治疗与漏率降低之间的显著关联难以解释，因此有必要仔细关注与吻合口漏相关的可改变的术前和围手术期患者因素。
