术后脓毒症对食管胃交界腺癌经裂孔食管切除术后1年死亡率和癌症复发的影响：一项回顾性观察研究

The Effect of Postoperative Sepsis on 1-Year Mortality and Cancer Recurrence Following Transhiatal Esophagectomy for Esophageal-Gastric Junction Adenocarcinomas: A Retrospective Observational Study.

作者信息

Faucher Marion, Dahan Samuel, Morel Bastien, de Guibert Jean Manuel, Chow-Chine Laurent, Gonzalez Frédéric, Bisbal Magali, Servan Luca, Sannini Antoine, Tezier Marie, Tourret Maxime, Cambon Sylvie, Pouliquen Camille, Mallet Damien, Nguyen Duong Lam, Ettori Florence, Mokart Djamel

机构信息

Department of Anesthesiology and Critical Care, Paoli-Calmettes Institute, 13009 Marseille, France.

出版信息

Cancers (Basel). 2025 Jan 1;17(1):109. doi: 10.3390/cancers17010109.

INTRODUCTION

Transhiatal esophagectomy (THE) is used for specific gastroesophageal junction adenocarcinomas. THE is a high-risk surgical procedure. We aimed to assess the impact of postoperative sepsis (sepsis or septic shock) on the 1-year mortality after THE and to determine the risk factors associated with these outcomes. Secondly, we aimed to assess the impact of postoperative sepsis and other risk factors on 1-year cancer recurrence.

METHOD

A retrospective, observational study was undertaken at the Paoli-Calmettes Institute, Marseille, from January 2012 to March 2022.

RESULTS

Of 118 patients, 24.6% (n = 29) presented with postoperative sepsis. Their 1-year mortality was 11% (n = 13), and their 1-year cancer recurrence was 23.7% (n = 28). In the multivariate analysis, independent factors for 1-year mortality were the following: postoperative sepsis (OR: 7.22 (1.11-47); = 0.038), number of lymph nodes removed (OR: 0. 78 (0.64-0.95); = 0.011), recurrence at one year (OR: 9.22 (1.66-51.1); = 0.011), mediastinitis (OR: 17.7 (1.43-220); = 0.025) and intraoperative driving pressure (OR: 1.77 (1.17-2.68); = 0.015). For postoperative sepsis, independent factors were low-dose vasopressors (OR: 0.26; 95% CI: 0.07-0.95; = 0.049), a cervical abscess (OR: 5.33; 95% CI: 1.5-18.9; = 0.01), bacterial pneumonia (OR: 11.1; 95% CI: 2.99-41.0; < 0.001) and a high SOFA score on day 1 (OR: 2.65; 95% CI: 1.36-5.19; = 0.04). For 1-year cancer recurrence, independent factors were the number of lymph nodes removed (sHR: 0.87; 95% CI: 0.79-0.96; = 0.005), pTNM stages of III or IV (sHR: 8.29; 95% CI: 2.71-25.32; < 0.001) and postoperative sepsis (sHR: 6.54; 95% CI: 1.70-25.13; = 0.005).

CONCLUSIONS

Our study indicates that after THE, postoperative sepsis influences survival and cancer recurrence. We identified the associated risk factors, suggesting an early diagnosis might decrease mortality and recurrence.

引言

经胸食管切除术（THE）用于特定的胃食管交界腺癌。THE是一种高风险的外科手术。我们旨在评估术后脓毒症（脓毒症或感染性休克）对THE术后1年死亡率的影响，并确定与这些结果相关的风险因素。其次，我们旨在评估术后脓毒症和其他风险因素对1年癌症复发的影响。

方法

于2012年1月至2022年3月在马赛的保利 - 卡尔梅特研究所进行了一项回顾性观察研究。

结果

118例患者中，24.6%（n = 29）出现术后脓毒症。他们的1年死亡率为11%（n = 13），1年癌症复发率为23.7%（n = 28）。在多变量分析中，1年死亡率的独立因素如下：术后脓毒症（比值比：7.22（1.11 - 47）；P = 0.038）、切除淋巴结数量（比值比：0.78（0.64 - 0.95）；P = 0.011）、1年复发（比值比：9.22（1.66 - 51.1）；P = 0.011）、纵隔炎（比值比：17.7（1.43 - 220）；P = 0.025）和术中驱动压（比值比：1.77（1.17 - 2.68）；P = 0.015）。对于术后脓毒症，独立因素为低剂量血管升压药（比值比：0.26；95%置信区间：0.07 - 0.95；P = 0.049）、颈部脓肿（比值比：5.33；95%置信区间：1.5 - 18.9；P = 0.01）、细菌性肺炎（比值比：11.1；95%置信区间：2.99 - 41.0；P < 0.001）和第1天的高序贯器官衰竭评估（SOFA）评分（比值比：2.65；95%置信区间：1.36 - 5.19；P = 0.04）。对于1年癌症复发，独立因素为切除淋巴结数量（标准化危险比：0.87；95%置信区间：0.79 - 0.96；P = 0.005）、III期或IV期的pTNM分期（标准化危险比：8.29；95%置信区间：2.71 - 25.32；P < 0.001）和术后脓毒症（标准化危险比：6.54；95%置信区间：1.70 - 25.13；P = 0.005）。