I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.
Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK.
Ann Surg Oncol. 2023 Sep;30(9):5564-5572. doi: 10.1245/s10434-023-13670-6. Epub 2023 May 20.
Anastomotic leak (AL) is a serious complication after esophagectomy. It is associated with prolonged hospital stay, increased costs, and increased risk for 90-day mortality. Controversy exists concerning the impact of AL on survival. This study was designed to investigate the effect of AL on long-term survival after esophagectomy for esophageal cancer.
PubMed, MEDLINE, Scopus, and Web of Science were searched through October 30, 2022. The included studies evaluated the effect of AL on long-term survival. Primary outcome was long-term overall survival. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures.
Thirteen studies (7118 patients) were included. Overall, 727 (10.2%) patients experienced AL. The RMSTD analysis shows that at 12, 24, 36, 48, and 60 months, patients not experiencing AL live an average of 0.7 (95% CI 0.2-1.2; p < 0.001), 1.9 (95% CI 1.1-2.6; p < 0.001), 2.6 (95% CI 1.6-3.7; p < 0.001), 3.4 (95% CI 1.9-4.9; p < 0.001), and 4.2 (95% CI 2.1-6.4; p < 0.001) months longer compared with those with AL, respectively. The time-dependent HRs analysis for AL versus no AL shows a higher mortality hazard in patients with AL at 3 (HR 1.94, 95% CI 1.54-2.34), 6 (HR 1.56, 95% CI 1.39-1.75), 12 (HR 1.47, 95% CI 1.24-1.54), and 24 months (HR 1.19, 95% CI 1.02-1.31).
This study seems to suggest a modest clinical impact of AL on long-term OS after esophagectomy. Patients who experience AL seem to have a higher mortality hazard during the first 2 years of follow-up.
吻合口漏（AL）是食管切除术后的一种严重并发症。它与住院时间延长、成本增加以及 90 天死亡率增加有关。关于 AL 对生存的影响存在争议。本研究旨在调查 AL 对食管癌食管切除术后长期生存的影响。
通过 PubMed、MEDLINE、Scopus 和 Web of Science 检索，截至 2022 年 10 月 30 日。纳入的研究评估了 AL 对长期生存的影响。主要结局为长期总生存。采用受限平均生存时间差（RMSTD）、风险比（HR）和 95%置信区间（CI）作为汇总效应量的测量指标。
纳入了 13 项研究（7118 例患者）。总体而言，727 例（10.2%）患者发生了 AL。RMSTD 分析显示，在 12、24、36、48 和 60 个月时，未发生 AL 的患者平均多存活 0.7（95%CI 0.2-1.2；p<0.001）、1.9（95%CI 1.1-2.6；p<0.001）、2.6（95%CI 1.6-3.7；p<0.001）、3.4（95%CI 1.9-4.9；p<0.001）和 4.2（95%CI 2.1-6.4；p<0.001）个月。AL 与无 AL 的时间依赖性 HR 分析显示，AL 患者在 3（HR 1.94，95%CI 1.54-2.34）、6（HR 1.56，95%CI 1.39-1.75）、12（HR 1.47，95%CI 1.24-1.54）和 24 个月（HR 1.19，95%CI 1.02-1.31）时的死亡风险更高。
本研究似乎表明 AL 对食管切除术后长期 OS 有适度的临床影响。发生 AL 的患者在随访的前 2 年内死亡风险较高。
