Giulini Luca, Kemeter Melissa, Farmaki Filitsa, Thumfart Lucas, Hüttner Felix J, Heger Patrick, Koch Oliver, Grechenig Michael, Weitzendorfer Michael, Emmanuel Klaus, Hitzl Wolfgang, Thiel Konstantin E, Diener Markus K, Dubecz Attila
Department of Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Department of Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
J Gastrointest Surg. 2025 Mar;29(3):101936. doi: 10.1016/j.gassur.2024.101936. Epub 2025 Jan 9.
Data about failure to rescue (FTR) after esophagectomy for cancer and its association with patient and procedure-related risk factors are limited. This study aimed to analyze such aspects, particularly focusing on the effect of pneumonia and anastomotic leak on FTR.
Patients who underwent an Ivor Lewis esophagectomy for cancer between 2008 and 2022 in 2 tertiary European centers were prospectively identified. Patients were classified and compared according to the type of operation (open, laparoscopic hybrid, robotic hybrid, minimally invasive, or robotic minimally invasive). FTR was defined as in-hospital death after a major complication. Risk factors for FTR were identified using a univariate model. Mortality after pneumonia and anastomotic leak were calculated and compared between the groups.
A total of 708 patients were included. There were 355 open procedures (50.1%), 204 laparoscopic hybrid procedures (28.8%), 121 hybrid robotic procedures (17.1%), 15 standard minimally invasive procedures (2.1%), and 11 robotic minimally invasive procedures (1.6%). The overall morbidity was 60.0%, and the FTR rate was 4.5%. Anastomotic leak, pneumonia, postoperative bleeding, sepsis, pulmonary embolism, arrhythmia, and need for blood transfusion were the risk factors significantly associated with in-hospital mortality (P <.05). There was no particular type of operation significantly associated with mortality (P =.42). Pneumonia- and leak-associated FTR rates did not significantly differ among the groups (P =.99).
Anastomotic leak and pneumonia are equally dangerous complications after esophagectomy for cancer. If performed in high-volume centers, hybrid or minimally invasive methods do not seem to negatively affect the FTR rates. Further efforts should be made to improve both tailored-approach and postoperative care.
食管癌切除术后未能挽救（FTR）的数据及其与患者和手术相关风险因素的关联有限。本研究旨在分析这些方面，特别关注肺炎和吻合口漏对FTR的影响。
前瞻性确定2008年至2022年期间在2个欧洲三级中心接受艾弗·刘易斯食管癌切除术的患者。根据手术类型（开放、腹腔镜杂交、机器人杂交、微创或机器人微创）对患者进行分类和比较。FTR定义为重大并发症后的院内死亡。使用单变量模型确定FTR的风险因素。计算并比较各组肺炎和吻合口漏后的死亡率。
共纳入708例患者。有355例开放手术（50.1%）、204例腹腔镜杂交手术（28.8%）、121例机器人杂交手术（17.1%）、15例标准微创手术（2.1%）和11例机器人微创手术（1.6%）。总体发病率为60.0%，FTR率为4.5%。吻合口漏、肺炎、术后出血、败血症、肺栓塞、心律失常和输血需求是与院内死亡率显著相关的风险因素（P<.05）。没有特定类型的手术与死亡率显著相关（P = 0.42）。各组之间肺炎和漏相关的FTR率没有显著差异（P = 0.99）。
吻合口漏和肺炎是食管癌切除术后同样危险的并发症。如果在高容量中心进行，杂交或微创方法似乎不会对FTR率产生负面影响。应进一步努力改善个体化治疗方法和术后护理。
