Tupper Haley I, Roybal Belia O, Jackson Riley W, Banks Kian C, Kwak Hyunjee V, Alcasid Nathan J, Wei Julia, Hsu Diana S, Velotta Jeffrey B
Division of General Surgery, Department of Surgery, University of California, Los Angeles, CA, United States.
Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States.
Front Surg. 2024 Feb 19;11:1348942. doi: 10.3389/fsurg.2024.1348942. eCollection 2024.
Esophagectomy, an esophageal cancer treatment mainstay, is a highly morbid procedure. Prolonged operative time, only partially predetermined by case complexity, may be uniquely harmful to minimally-invasive esophagectomy (MIE) patients for numerous reasons, including anastomotic leak, tenuous conduit perfusion and protracted single-lung ventilation, but the impact is unknown. This multi-center retrospective cohort study sought to characterize the relationship between MIE operative time and post-operative outcomes.
We abstracted multi-center data on esophageal cancer patients who underwent MIE from 2010 to 2021. Predictor variables included age, sex, comorbidities, body mass index, prior cardiothoracic surgery, stage, and neoadjuvant therapy. Outcomes included complications, readmissions, and mortality. Association analysis evaluated the relationship between predictor variables and operative time. Multivariate logistic regression characterized the influence of potential predictor variables and operative time on post-operative outcomes. Subgroup analysis evaluated the association between MIE >4 h vs. ≤4 h and complications, readmissions and survival.
For the 297 esophageal cancer patients who underwent MIE between 2010 and 2021, the median operative duration was 4.8 h [IQR: 3.7-6.3]. For patients with anastomotic leak (5.1%) and 1-year mortality, operative duration was elevated above the median at 6.3 h [IQR: 4.8-8.6], = 0.008) and 5.3 h [IQR: 4.4-6.8], = 0.04), respectively. In multivariate logistic regression, each additional hour of operative time increased the odds of anastomotic leak and 1-year mortality by 39% and 19%, respectively.
Esophageal cancer is a poor prognosis disease, even with optimal treatment. Operative efficiency, a modifiable surgical variable, may be an important target to improve MIE patient outcomes.
食管癌治疗的主要手段——食管切除术，是一种具有高并发症发生率的手术。手术时间延长虽部分由病例复杂性决定，但可能对微创食管切除术（MIE）患者造成独特危害，原因众多，包括吻合口漏、脆弱的管道灌注和长时间的单肺通气，但其影响尚不清楚。这项多中心回顾性队列研究旨在描述MIE手术时间与术后结果之间的关系。
我们提取了2010年至2021年接受MIE的食管癌患者的多中心数据。预测变量包括年龄、性别、合并症、体重指数、既往心胸外科手术史、分期和新辅助治疗。结果包括并发症、再入院率和死亡率。关联分析评估预测变量与手术时间之间的关系。多因素逻辑回归分析潜在预测变量和手术时间对术后结果的影响。亚组分析评估手术时间>4小时与≤4小时的MIE与并发症、再入院率和生存率之间的关联。
对于2010年至2021年间接受MIE的297例食管癌患者，中位手术时长为4.8小时[四分位间距：3.7 - 6.3]。对于发生吻合口漏的患者（5.1%）和1年死亡率，手术时长分别高于中位数，为6.3小时[四分位间距：4.8 - 8.6]，P = 0.008）和5.3小时[四分位间距：4.4 - 6.8]，P = 0.04）。在多因素逻辑回归分析中，手术时间每增加一小时，吻合口漏的几率和1年死亡率分别增加39%和19%。
食管癌即使接受最佳治疗，预后也较差。手术效率是一个可改变的手术变量，可能是改善MIE患者预后的重要靶点。
