食管癌切除术后良性吻合口狭窄的危险因素

Risk Factors for Benign Anastomotic Stenosis After Esophagectomy for Cancer.

作者信息

van der Aa Dillen C, Boonstra Jelle, Eshuis Wietse J, Daams Freek, Pouw Roos E, Gisbertz Suzanne S, van Berge Henegouwen Mark I

机构信息

Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.

Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.

出版信息

Ann Surg Oncol. 2025 May 6. doi: 10.1245/s10434-025-17401-x.

DOI:10.1245/s10434-025-17401-x

PMID:40327192

Abstract

BACKGROUND

Benign stenosis frequently occurs after esophagectomy, causing dysphagia, eating problems, and diminished quality of life. This study aimed to identify risk factors for benign anastomotic stenosis after esophagectomy for cancer.

METHODS

This retrospective cohort study analyzed patients who underwent esophagectomy at Amsterdam UMC from 2012 until 2022. Intrathoracic and cervical anastomoses were examined separately. Benign anastomotic stenosis was defined as stenosis at the anastomosis causing dysphagia (Ogilvie score ≥2) and requiring at least one endoscopic dilation. Predictive factors were identified using logistic regression.

RESULTS

The study enrolled 902 patients: 605 with intrathoracic and 297 with cervical anastomosis. Of these cases, 91.1 % were a minimally invasive esophagectomy. Stenosis occurred in 18.4 % of the intrathoracic cases and 49.8 % of the cervical cases (p < 0.001). The patients required medians of 4 and 7 dilations, respectively (p = 0.001). The median time to stenosis was 99 days for the intrathor days for the cervical anastomoses (p = 0.001). Intrathoracic stenosis was independently associated with anastomotic leakage (odds ratio [OR], 2.034; 95 % confidence interval [CI], 1.116-3.708). For the patients without leakage, a 2 mm versus a 25 mm circular stapler reduced stenosis risk (OR, 0.486; 95 % CI, 0.294-0.803), whereas use of immunosuppressants (OR, 3.492; 95 % CI, 1.186-10.279]) and chronic pulmonary disease (OR, 2.717; 95 % CI, 1.293-5.707) increased it. For cervical anastomoses, hand-sewn end-to-side anastomosis was protective (OR, 0.454; 95 % CI, 0.234-0.879).

CONCLUSIONS

The key risk factors for intrathoracic benign anastomotic stenosis are anastomotic leakage, smaller circular stapler size, use of immunosuppressants, and chronic pulmonary disease. For cervical anastomoses, the hand-sewn end-to side technique is protective compared with the end-to-end technique, whereas use of immunosuppressants and chronic pulmonary disease increases the risk.

摘要

背景

良性狭窄在食管切除术后经常发生，导致吞咽困难、进食问题和生活质量下降。本研究旨在确定癌症食管切除术后良性吻合口狭窄的危险因素。

方法

这项回顾性队列研究分析了2012年至2022年在阿姆斯特丹大学医学中心接受食管切除术的患者。分别检查胸内和颈部吻合口。良性吻合口狭窄定义为吻合口处狭窄导致吞咽困难（奥吉尔维评分≥2）且至少需要一次内镜扩张。使用逻辑回归确定预测因素。

结果

该研究纳入了902例患者：605例胸内吻合和297例颈部吻合。在这些病例中，91.1%为微创食管切除术。胸内病例狭窄发生率为18.4%，颈部病例为49.8%（p<0.001）。患者分别需要中位数为4次和7次扩张（p=0.001）。胸内吻合口狭窄的中位时间为99天，颈部吻合口为116天（p=0.001）。胸内狭窄与吻合口漏独立相关（比值比[OR]，2.034；95%置信区间[CI]，1.116-3.708）。对于无漏的患者，2mm与25mm圆形吻合器相比可降低狭窄风险（OR，0.486；95%CI，0.294-0.803），而使用免疫抑制剂（OR，3.492；95%CI，1.186-10.279）和慢性肺病（OR，2.717；95%CI，1.293-5.707）会增加狭窄风险。对于颈部吻合口，手工缝合端侧吻合具有保护作用（OR，0.454；95%CI，0.234-0.879）。