Pollmann Lukas, Linnemann Jonas, Pollmann Nicola S, Jürgens Claudius, Schmeding Maximilian
Department of General and Visceral Surgery, Klinikum Dortmund gGmbH, Dortmund, Witten/Herdecke University, Beurhausstraße 40, 44137, Dortmund, Germany.
Department of General-, Visceral and Transplant Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
Langenbecks Arch Surg. 2025 May 14;410(1):157. doi: 10.1007/s00423-025-03727-3.
Proton pump inhibitors (PPIs) are indispensable in the treatment of gastro-esophageal reflux disease and peptic ulcers or for the prevention of stress ulcers after major abdominal surgery. However, long-term PPI therapy leads to several side effects such as delayed gastric emptying and distinct changes in mucosal histology. Therefore, this retrospective study aims to evaluate the impact of preoperative PPI therapy on the anastomotic leak rate after esophagectomy.
A retrospective, single-center analysis was conducted for all patients treated with esophagectomy and gastric conduit reconstruction between January 2016 and November 2024. Preoperative treatment with PPIs, as well as patient comorbidities, histopathological findings and surgical techniques were noted. Subsequently, a group-wise comparison was carried out for the differences in anastomotic leak rate and postoperative complications in patients with and without preoperative PPI therapy. Finally, a multivariate logistic regression analysis was conducted for the occurrence of anastomotic leak.
A total of 229 patients were included in the study. The group-wise comparison revealed a significantly higher rate of anastomotic leaks and postoperative complications in patients with preoperative PPI therapy compared to those without. The multivariate logistic regression analysis indicated a 2.5-fold increased risk of anastomotic leaks in patients with preoperative PPI therapy compared to patients without.
Preoperative PPI therapy may represent a modifiable risk factor for the development of anastomotic leaks after esophagectomy. Further prospective, interventional studies are necessary to verify the results.
The study was retrospectively registered in the German clinical trial database (Application number DRKS00035536, Registration date 03.12.2024).
质子泵抑制剂（PPIs）在胃食管反流病和消化性溃疡的治疗中或在预防腹部大手术后的应激性溃疡方面不可或缺。然而，长期使用PPI治疗会导致多种副作用，如胃排空延迟和黏膜组织学明显改变。因此，本回顾性研究旨在评估术前PPI治疗对食管切除术后吻合口漏发生率的影响。
对2016年1月至2024年11月期间所有接受食管切除术和胃管道重建的患者进行回顾性单中心分析。记录术前使用PPI的治疗情况，以及患者的合并症、组织病理学检查结果和手术技术。随后，对接受和未接受术前PPI治疗的患者在吻合口漏发生率和术后并发症方面的差异进行分组比较。最后，对吻合口漏的发生情况进行多因素逻辑回归分析。
本研究共纳入229例患者。分组比较显示，与未接受术前PPI治疗的患者相比，接受术前PPI治疗的患者吻合口漏和术后并发症的发生率显著更高。多因素逻辑回归分析表明，与未接受术前PPI治疗的患者相比，接受术前PPI治疗的患者发生吻合口漏的风险增加了2.5倍。
术前PPI治疗可能是食管切除术后发生吻合口漏的一个可改变的风险因素。需要进一步进行前瞻性干预研究以验证结果。
本研究在德国临床试验数据库中进行了回顾性注册（申请号DRKS00035536，注册日期2-024年12月3日）。
