“食管并发症共识小组”（ECCG）分类在杂交 Ivor-Lewis 食管切除术吻合口漏中的临床实用性和适用性。

Clinical utility and applicability of the,Esophagus Complication Consensus Group' (ECCG) classification of anastomotic leakage following hybrid Ivor-Lewis esophagectomy.

机构信息

Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany.

Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany.

出版信息

Langenbecks Arch Surg. 2023 Jun 30;408(1):258. doi: 10.1007/s00423-023-03001-4.

DOI:10.1007/s00423-023-03001-4

PMID:37391512

Abstract

BACKGROUND

Anastomotic leakage (AL) remains the leading surgical complication following Ivor-Lewis (IL) esophagectomy. Different treatment options of AL exist but outcome is difficult to compare due to a lack of generally accepted classifications. This retrospective study was conducted to analyze the clinical significance of a recently proposed classification based on the management of AL.

PATIENTS AND METHODS

A cohort of 954 consecutive patients undergoing hybrid IL esophagectomy (laparoscopy/thoracotomy) was analysed. AL was defined according to the,Esophagus Complication Consensus Group' (ECCG) criteria depending on its treatment: conservative (AL type I), interventional endoscopic (AL type II), and surgical (AL type III). Primary outcome was single or multiple organ failure (Clavien-Dindo IVA/B) associated with AL.

RESULTS

Overall morbidity was 63.0% and 8.8% (84/954 patients) developed an AL postoperatively. Three patients (3.5%) had an AL type I, 57 patients (67.9%) an AL type II and 24 patients (28.6%) an AL type III. For patients managed surgically, AL was diagnosed significantly earlier (median days: AL type III: 2 vs AL type II: 6, p < 0.001). Associated organ failure (CD IVA/B) was significantly lower for AL type II as compared to AL type III (21.1% versus 45.8%, p < 0.0001). In-hospital mortality was 3.5% for AL type II and 8.3% for AL type III (p = 0.789). There was no difference for re-admission to ICU and overall length of hospital stay.

CONCLUSION

The proposed ECCG classification is simply to apply and discriminates the post-treatment severity of AL but does not aid to implement a treatment algorithm.

摘要

背景

吻合口瘘（AL）仍然是 Ivor-Lewis（IL）食管切除术的主要手术并发症。存在不同的治疗选择，但由于缺乏普遍接受的分类，因此难以比较结果。本回顾性研究旨在分析基于最近提出的吻合口瘘分类的临床意义，该分类基于吻合口瘘的管理。

患者和方法

分析了 954 例连续接受杂交 IL 食管切除术（腹腔镜/开胸术）的患者队列。根据吻合口瘘的治疗方法，根据“食管并发症共识小组”（ECCG）标准定义吻合口瘘：保守治疗（AL 型 I）、介入内镜治疗（AL 型 II）和手术治疗（AL 型 III）。主要结局是与吻合口瘘相关的单一或多器官衰竭（Clavien-Dindo IVA/B）。

结果

总发病率为 63.0%，8.8%（954 例患者中有 84 例）术后发生吻合口瘘。3 例（3.5%）为 AL 型 I，57 例（67.9%）为 AL 型 II，24 例（28.6%）为 AL 型 III。对于接受手术治疗的患者，吻合口瘘的诊断时间明显更早（中位数天数：AL 型 III：2 天 vs AL 型 II：6 天，p<0.001）。与 AL 型 III 相比，AL 型 II 发生相关器官衰竭（CD IVA/B）的比例明显较低（21.1%比 45.8%，p<0.0001）。AL 型 II 的院内死亡率为 3.5%，AL 型 III 为 8.3%（p=0.789）。再入住 ICU 和总住院时间无差异。