Department of Gastrointestinal Surgery, Kanazawa University, Kanazawa, Japan.
Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Anticancer Res. 2024 Apr;44(4):1719-1726. doi: 10.21873/anticanres.16971.
BACKGROUND/AIM: Anastomotic leakage is one of the most common and serious postoperative complications following esophagectomy. This study analyzed the effect of risk factors, such as the degree of arteriosclerosis, comorbidities, and patient characteristics on the incidence of reconstruction-related complications including anastomotic leakage. Furthermore, the usefulness of tailor-made reconstruction methods was clarified using wide gastric conduit.
Patients who underwent esophagectomy with a gastric conduit for esophageal cancer between 2011 and 2018 were enrolled. In the initial group that underwent esophagectomy between August 2011 and February 2016, gastrointestinal reconstruction was performed using a narrow gastric conduit. In the latter group, reconstruction using subtotal gastric conduit was selected for high-risk patients between March 2016 and March 2018. Postoperative complications including reconstruction-related complications were assessed.
The occurrence of anastomotic leakage was significantly associated with the patient's risk in the initial group. The rates of anastomotic leakage and reconstruction-related complications were significantly lower in the latter group than in the initial group (3.2% vs. 23.0%, p=0.001; 27.0% vs. 44.3%, p=0.044). The incidence of all complications was significantly lower in the latter group than in the initial group (28.6% vs. 59.0%, p=0.001). The change in bodyweight loss one year after the operation was significantly lower in the latter group than in the initial group (p=0.042).
Tailor-made reconstruction using wide gastric conduit for high-risk cases of esophageal cancer could reduce the occurrence of anastomotic leakage and promote a better quality of life after surgery.
背景/目的：吻合口瘘是食管癌手术后最常见和最严重的并发症之一。本研究分析了动脉硬化程度、合并症和患者特征等危险因素对包括吻合口瘘在内的重建相关并发症发生率的影响。此外，还通过使用宽胃管阐明了定制重建方法的有用性。
纳入了 2011 年至 2018 年间接受胃管食管切除术治疗食管癌的患者。在 2011 年 8 月至 2016 年 2 月接受食管切除术的初始组中，采用窄胃管进行胃肠重建。在后一组中，2016 年 3 月至 2018 年 3 月期间，为高危患者选择了全胃管重建。评估了包括重建相关并发症在内的术后并发症。
吻合口瘘的发生与初始组中患者的风险显著相关。在后一组中，吻合口瘘和重建相关并发症的发生率明显低于初始组（3.2%比 23.0%，p=0.001；27.0%比 44.3%，p=0.044）。后一组的所有并发症发生率明显低于初始组（28.6%比 59.0%，p=0.001）。后一组术后一年体重减轻的发生率明显低于初始组（p=0.042）。
为高危食管癌患者采用宽胃管定制重建可以减少吻合口瘘的发生，提高术后生活质量。
