影响微创Ivor Lewis食管癌切除术后并发症的因素：一项回顾性队列研究

Factors Influencing Postoperative Complications Following Minimally Invasive Ivor Lewis Esophagectomy: A Retrospective Cohort Study.

作者信息

Peters Antje K, Juratli Mazen A, Roy Dhruvajyoti, Merten Jennifer, Fortmann Lukas, Pascher Andreas, Hoelzen Jens Peter

机构信息

Department of General, Visceral and Transplant Surgery, University Hospital Muenster, 48149 Muenster, Germany.

Institute of Medical Psychology and Systems Neuroscience, University of Muenster, 48149 Muenster, Germany.

出版信息

J Clin Med. 2023 Aug 31;12(17):5688. doi: 10.3390/jcm12175688.

DOI:10.3390/jcm12175688

PMID:37685756

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10488704/

Abstract

BACKGROUND

Complications arising following minimally invasive Ivor Lewis esophagectomy often result from inadequate enteral nutrition, highlighting the need for proactive measures to prevent such issues. One approach involves identifying high-risk cases prone to complications and implementing percutaneous endoscopic jejunostomy (PEJ) tube placement during esophageal resection to ensure timely enteral nutrition.

METHODS

In this single-center, retrospective cohort study, we examined patients who underwent minimally invasive esophagectomy for esophageal cancer at a high-volume center. The dataset encompassed demographic information, comorbidities, laboratory parameters, and intraoperative details. Our center utilized the EndoVac system pre-emptively to safeguard the anastomosis from harmful secretions and to enhance local oxygen partial pressure. All patients received pre-emptive EndoVac therapy and underwent esophagogastroduodenoscopy in the early postoperative days. The need for multiple postoperative EndoVac cycles indicated complications, including anastomotic insufficiency and subsequent requirement for a PEJ. The primary objectives were identifying predictive factors for anastomotic insufficiency and the need for multi-cycle EndoVac therapy, quantifying their effects, and assessing the likelihood of postoperative complications.

RESULTS

149 patients who underwent minimally invasive or hybrid Ivor Lewis esophagectomy were analyzed and 21 perioperative and demographic features were evaluated. Postoperative complications were associated with the body mass index (BMI) category, the use of blood pressure medication, and surgery duration. Anastomotic insufficiency as a specific complication was correlated with BMI and the Charlson comorbidity index. The odds ratio of being in the high-risk group significantly increased with higher BMI (OR = 1.074, = 0.048) and longer surgery duration (OR = 1.005, = 0.004).

CONCLUSIONS

Based on our findings, high BMI and longer surgery duration are potential risk factors for postoperative complications following minimally invasive esophagectomy. Identifying such factors can aid in pre-emptively addressing nutritional challenges and reducing the incidence of complications in high-risk patients.

摘要

背景

微创Ivor Lewis食管切除术后出现的并发症通常是由于肠内营养不足所致，这凸显了采取积极措施预防此类问题的必要性。一种方法是识别易发生并发症的高危病例，并在食管切除术中实施经皮内镜下空肠造口术（PEJ）置管，以确保及时进行肠内营养。

方法

在这项单中心回顾性队列研究中，我们对一家大型中心接受微创食管癌切除术的患者进行了检查。数据集包括人口统计学信息、合并症、实验室参数和术中细节。我们中心预防性地使用EndoVac系统来保护吻合口免受有害分泌物的影响，并提高局部氧分压。所有患者均接受预防性EndoVac治疗，并在术后早期接受食管胃十二指肠镜检查。术后需要多次EndoVac治疗周期表明存在并发症，包括吻合口漏以及随后对PEJ的需求。主要目标是确定吻合口漏和多周期EndoVac治疗需求的预测因素，量化其影响，并评估术后并发症的可能性。

结果

对149例行微创或杂交Ivor Lewis食管切除术的患者进行了分析，并评估了21项围手术期和人口统计学特征。术后并发症与体重指数（BMI）类别、血压药物的使用和手术时间有关。作为一种特定并发症的吻合口漏与BMI和Charlson合并症指数相关。随着BMI升高（OR = 1.074，P = 0.048）和手术时间延长（OR = 1.005，P = 0.004），高危组的比值比显著增加。