Takahashi Naoki, Okamura Akihiko, Kuriyama Kengo, Terayama Masayoshi, Tamura Masahiro, Kanamori Jun, Imamura Yu, Watanabe Masayuki
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Ann Surg Oncol. 2025 Feb;32(2):834-840. doi: 10.1245/s10434-024-16534-9. Epub 2024 Nov 16.
Anastomotic leakage (AL) is a major complication after esophagectomy for esophageal cancer, and the significance of elevated postoperative lactate levels in the occurrence of AL is unclear.
We evaluated 583 patients who underwent minimally invasive esophagectomy for esophageal cancer. Serum lactate levels were measured immediately after esophagectomy and in the morning on postoperative days (POD) 1, 2, 3, and 4. We also evaluated the factors associated with AL using multivariable logistic regression analysis.
AL occurred in 8.9% (n = 52) of patients, and the median onset of AL was POD10 (interquartile range: 7-13). The lactate levels immediately after esophagectomy through POD3 were significantly higher in patients with AL than in those without AL. A further multivariable logistic regression analysis showed that elevated lactate level on POD2 was an independent predictor of the occurrence of AL (odds ratio 11.9; 95% confidence interval: 4.04-17.3; P < 0.001). Severe AL was significantly more frequent in the higher lactate patients (P < 0.001). Furthermore, in patients with AL with higher lactate, the onset tended to be earlier (P = 0.054), and the treatment duration of AL was significantly longer compared with those with lower lactate (P = 0.037).
AL was significantly associated with elevated postoperative lactate levels. Elevated lactate levels on POD2 could be significant predictor of AL development after esophagectomy.
吻合口漏（AL）是食管癌食管切除术后的主要并发症，术后乳酸水平升高在AL发生中的意义尚不清楚。
我们评估了583例行微创食管癌切除术的患者。在食管切除术后即刻以及术后第1、2、3和4天早晨测量血清乳酸水平。我们还使用多变量逻辑回归分析评估了与AL相关的因素。
8.9%（n = 52）的患者发生了AL，AL的中位发病时间为术后第10天（四分位间距：7 - 13天）。发生AL的患者在食管切除术后至术后第3天的乳酸水平显著高于未发生AL的患者。进一步的多变量逻辑回归分析显示，术后第2天乳酸水平升高是AL发生的独立预测因素（比值比11.9；95%置信区间：4.04 - 17.3；P < 0.001）。乳酸水平较高的患者中严重AL更为常见（P < 0.001）。此外，在乳酸水平较高的AL患者中，发病往往更早（P = 0.054），且与乳酸水平较低的患者相比，AL的治疗持续时间显著更长（P = 0.037）。
AL与术后乳酸水平升高显著相关。术后第2天乳酸水平升高可能是食管切除术后AL发生的重要预测指标。
