Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, United States.
Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, United States.
J Gastrointest Surg. 2024 Oct;28(10):1622-1628. doi: 10.1016/j.gassur.2024.07.020. Epub 2024 Jul 30.
The aim of this study was to determine perioperative risk factors associated with anastomotic leak (AL) after minimally invasive esophagectomy (MIE) and its association with cancer recurrence and overall survival.
This retrospective observational study of electronic health record data included patients who underwent MIE for esophageal cancer between September 2013 and July 2023 at a tertiary center. The primary outcome was AL after esophagectomy, whereas the secondary outcomes included time to cancer recurrence and overall survival. Perioperative patient factors were evaluated to determine their associations with the primary and the secondary outcomes. Propensity score-matched logistic regression assessed the associations between perioperative factors and AL. Kaplan-Meier survival curves compared cancer recurrence and overall survival by AL.
A total of 251 consecutive patients with esophageal cancer were included in the analysis; 15 (6%) developed AL. Anemia, hospital complications, hospital length of stay, and 30-day readmissions significantly differed from those with and without AL (P = .037, <.001, <.001, and.016, respectively). Moreover, 30- and 90-day mortality were not statistically affected by the presence of AL (P = .417 and 0.456, respectively). Logistic regression modeling showed drug history and anemia were significantly associated with AL (P = .022 and.011, respectively). The presence of AL did not significantly impact cancer recurrence or overall survival (P = .439 and.301, respectively).
The etiology of AL is multifactorial. Moreover, AL is significantly associated with drug history, preoperative anemia, hospital length of stay, and 30-day readmissions, but it was not significantly associated with 30- or 90-day mortality, cancer recurrence, or overall survival. Patients should be optimized before undergoing MIE with special consideration for correcting anemia. Ongoing research is needed to identify more modifiable risk factors to minimize AL development and its associated morbidity.
本研究旨在确定微创食管切除术（MIE）后吻合口漏（AL）的围手术期相关风险因素及其与癌症复发和总生存的关系。
本回顾性观察性研究利用电子病历数据，纳入 2013 年 9 月至 2023 年 7 月在一家三级中心接受 MIE 治疗食管癌的患者。主要结局是手术后发生 AL，次要结局包括癌症复发时间和总生存时间。评估围手术期患者因素，以确定其与主要和次要结局的关系。倾向评分匹配的逻辑回归评估围手术期因素与 AL 的关系。Kaplan-Meier 生存曲线比较了 AL 患者的癌症复发和总生存情况。
共纳入 251 例连续食管癌患者，其中 15 例（6%）发生 AL。贫血、医院并发症、住院时间和 30 天再入院与 AL 患者显著不同（P=0.037，<.001，<.001，和.016，分别）。此外，30 天和 90 天死亡率不受 AL 存在的影响（P=0.417 和 0.456，分别）。逻辑回归模型显示，药物史和贫血与 AL 显著相关（P=0.022 和.011，分别）。AL 的存在并未显著影响癌症复发或总生存（P=0.439 和.301，分别）。
AL 的病因是多因素的。此外，AL 与药物史、术前贫血、住院时间和 30 天再入院显著相关，但与 30 天或 90 天死亡率、癌症复发或总生存无关。在接受 MIE 之前，患者应进行优化，特别注意纠正贫血。需要进一步的研究来确定更多可改变的风险因素，以最大限度地减少 AL 的发生及其相关发病率。
