Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, University of Texas, Holcombe Boulevard, Houston, TX.
Ann Surg. 2024 Jul 1;280(1):91-97. doi: 10.1097/SLA.0000000000006266. Epub 2024 Apr 4.
To investigate overall survival and length of stay (LOS) associated with differing management for high output (>1 L over 24 hours) leaks (HOCL) after cancer-related esophagectomy.
Although infrequent, chyle leak after esophagectomy is an event that can lead to significant perioperative sequelae. Low-volume leaks appear to respond to nonoperative measures, whereas HOCLs often require invasive therapeutic interventions.
From a prospective single-institution database, we retrospectively reviewed patients treated from 2001 to 2021 who underwent esophagectomy for esophageal cancer. Within that cohort, we focused on a subgroup of patients who manifested a HOCL postoperatively. Clinicopathologic and operative characteristics were collected, including hospital LOS and survival data.
A total of 53/2299 patients manifested a HOCL. These were mostly males (77%), with a mean age of 62 years. Of this group, 15 patients received nonoperative management, 15 patients received prompt (<72 hours from diagnosis) interventional management, and 23 received late interventional management. Patients in the late intervention group had longer LOSs compared with early intervention (slope = 9.849, 95% CI: 3.431-16.267). Late intervention (hazard ratio: 4.772, CI: 1.384-16.460) and nonoperative management (hazard ratio: 4.731, CI: 1.294-17.305) were associated with increased mortality compared with early intervention. Patients with early intervention for HOCL had an overall survival similar to patients without chyle leaks in survival analysis.
Patients with HOCL should receive early intervention to possibly reverse the prognostic implications of this potentially detrimental complication.
研究与癌症相关的食管切除术后高输出量（>24 小时 1 升以上）漏（HOCL）不同处理方法相关的总生存和住院时间（LOS）。
尽管罕见，但食管癌切除术后乳糜漏是一种可能导致重大围手术期后果的事件。低容量漏似乎对非手术措施有反应，而高输出量漏则经常需要侵入性治疗干预。
我们从一个前瞻性的单机构数据库中回顾性地审查了 2001 年至 2021 年接受食管癌切除术治疗食管癌的患者。在该队列中，我们重点关注术后表现出 HOCL 的患者亚组。收集了临床病理和手术特征，包括住院 LOS 和生存数据。
共有 53/2299 例患者表现出 HOCL。这些患者主要为男性（77%），平均年龄为 62 岁。在这一组中，15 例患者接受了非手术治疗，15 例患者接受了早期（诊断后<72 小时）介入治疗，23 例患者接受了晚期介入治疗。与早期干预相比，晚期干预组的 LOS 更长（斜率=9.849，95%CI：3.431-16.267）。晚期干预（危险比：4.772，CI：1.384-16.460）和非手术治疗（危险比：4.731，CI：1.294-17.305）与早期干预相比，死亡率增加。HOCL 早期干预的患者与无乳糜漏的患者在生存分析中具有相似的总体生存率。
HOCL 患者应接受早期干预，以可能逆转这一潜在有害并发症的预后影响。
