Stüben Björn-Ole, Plitzko Gabriel Andreas, Stern Louisa, Schmeding Rainer, Karstens Karl-Frederick, Reeh Matthias, Treckmann Jürgen Walter, Izbicki Jakob Robert, Saner Fuat Hakan, Neuhaus Jan Peter, Tachezy Michael, Hoyer Dieter Paul
Department of General-, Visceral- and Transplant Surgery, Medical Center University Duisburg-Essen, 45147 Essen, Germany.
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
J Clin Med. 2024 Feb 17;13(4):1137. doi: 10.3390/jcm13041137.
Esophagectomy carries a high risk of morbidity and mortality compared to other major surgeries. With the aim of creating an easy-to-use clinical preoperative risk assessment tool and to validate previously described risk factors for major complications following surgery, esophagectomies at two tertiary medical centers were analyzed.
A total of 450 patients who underwent esophagectomy for esophageal carcinoma at the University Medical Centre, Hamburg, or at the Medical Center University Duisburg-Essen, Germany (January 2008 to January 2020) were retrospectively analyzed. Epidemiological and perioperative data were analyzed to identify the risk factors that impact major complication rates. The primary endpoint of this study was to determine the incidence of major complications.
The mean age of the patients was 63 years with a bimodal distribution. There was a male predominance across the cohort (81% vs. 19%, respectively). Alcohol abuse ( = 0.0341), chronic obstructive pulmonary disease ( = 0.0264), and cardiac comorbidity ( = 0.0367) were associated with a significantly higher risk of major complications in the multivariate analysis. Neoadjuvant chemotherapy significantly reduced the risk of major postoperative complications ( < 0.0001).
Various patient-related risk factors increased the rate of major complications following esophagectomy. Patient-tailored prehabilitation programs before esophagectomy that focus on minimizing these risk factors may lead to better surgical outcomes and should be analyzed in further studies.
与其他大型手术相比，食管癌切除术的发病和死亡风险较高。为了创建一种易于使用的临床术前风险评估工具，并验证先前描述的术后主要并发症的风险因素，对两家三级医疗中心的食管癌切除术进行了分析。
回顾性分析了2008年1月至2020年1月在德国汉堡大学医学中心或杜伊斯堡-埃森大学医学中心接受食管癌切除术的450例患者。分析了流行病学和围手术期数据，以确定影响主要并发症发生率的风险因素。本研究的主要终点是确定主要并发症的发生率。
患者的平均年龄为63岁，呈双峰分布。整个队列中男性占主导地位（分别为81%和19%）。在多变量分析中，酗酒（P = 0.0341）、慢性阻塞性肺疾病（P = 0.0264）和心脏合并症（P = 0.0367）与主要并发症的风险显著升高相关。新辅助化疗显著降低了术后主要并发症的风险（P < 0.0001）。
各种与患者相关的风险因素增加了食管癌切除术后主要并发症的发生率。食管癌切除术前针对患者的预康复计划，重点是尽量减少这些风险因素，可能会带来更好的手术效果，应在进一步研究中进行分析。
