Cardiothoracic Surgery Department, the first Affiliated Hospital of Anhui University of Science & Technology (Huainan First People's Hospital), Huainan, 232001, Anhui Province, China.
BMC Surg. 2024 Sep 13;24(1):260. doi: 10.1186/s12893-024-02562-5.
Esophageal cancer is currently one of the high-risk malignant tumors worldwide, posing a serious threat to human health. This study aimed to analyse the causes of postoperative mortality and intrathoracic anastomotic leakage(IAL) after esophagectomy.
A retrospective analysis was conducted on 172 patients with esophageal cancer resection and focused on the preoperative and postoperative indicators. Cox regression analysis was performed to identify factors affected IAL and evaluated the potential factors on postoperative mortality. The Kaplan-Meier curve was applied to evaluate the effect of leakage on postoperative mortality after propensity score matching.
Univariable and multivariable Cox regression analysis showed that infection and high BMI were significant risk factors for IAL, patients with BMI over 24 kg/m in IAL group was two times higher than that of the group without IAL (95% CI = 1.01-6.38; P = 0.048). When patients were infected, the hazard ratios(HRs) of anastomotic leakage was twice that of patients without infection (95% CI = 1.22-4.70; P = 0.011). On the other hand, IAL was a significant cause of postoperative mortality, the 40-day postoperative mortality rate in the leakage group was significantly higher than the non leakage group (28.95% in leakage group vs. 7.46% in non leakage group, P<0.01). After propensity score matching, IAL still significantly affected postoperative mortality. The total length of hospital stay of the leakage group was inevitably longer than that of the non leakage group (22.19 ± 10.79 vs. 15.27 ± 8.59).
IAL was a significant cause of death in patients underwent esophageal cancer resection. Patients with high BMI over 24 kg/m and infection may be more prone to developing IAL after esophagectomy. IAL inevitably prolonged the length of hospital stay and increased postoperative mortality.
食管癌目前是全球高发的恶性肿瘤之一，严重威胁人类健康。本研究旨在分析食管癌手术后死亡率和胸内吻合口瘘（IAL）的原因。
回顾性分析 172 例食管癌切除术患者的术前和术后指标。采用 Cox 回归分析确定影响 IAL 的因素，并评估术后死亡率的潜在因素。采用 Kaplan-Meier 曲线评估匹配倾向评分后吻合口漏对术后死亡率的影响。
单变量和多变量 Cox 回归分析表明，感染和高 BMI 是 IAL 的显著危险因素，IAL 组 BMI 超过 24kg/m2的患者是非 IAL 组的两倍（95%CI=1.01-6.38；P=0.048）。当患者感染时，吻合口漏的危险比（HR）是非感染患者的两倍（95%CI=1.22-4.70；P=0.011）。另一方面，IAL 是术后死亡的重要原因，漏诊组的 40 天术后死亡率明显高于无漏诊组（漏诊组 28.95%，无漏诊组 7.46%，P<0.01）。经倾向评分匹配后，IAL 仍显著影响术后死亡率。漏诊组的总住院时间不可避免地长于无漏诊组（22.19±10.79 与 15.27±8.59，P<0.01）。
IAL 是食管癌切除术后患者死亡的重要原因。BMI 超过 24kg/m2和感染的患者可能更容易在食管癌手术后发生 IAL。IAL 不可避免地延长了住院时间并增加了术后死亡率。
