Ramos-Fresnedo Andres, Mobley Erin M, Pather Keouna, Yap Chelsea R, Celso Brian G, Awad Ziad T
Department of Surgery, University of Florida, 655 8th Street S, Jacksonville, FL, 32209, USA.
Surg Endosc. 2025 Jul 14. doi: 10.1007/s00464-025-11949-1.
To explore the clinical factors associated with failure to rescue (FTR) among patients who underwent minimally invasive Ivor Lewis esophagectomy (MIE).
Retrospective analysis of all adults (≥ 18 years) who underwent a MIE from September 2013 to September 2023. FTR was defined as mortality rate among patients who developed any postoperative complication (any Clavien-Dindo grade). Univariable logistic regression was used to determine which factors were associated with FTR and those significant at p < 0.05 were entered into a multivariable model. Additionally, a stratified analysis was performed to explore the factors associated with FTR among those patients who developed life-threatening complications (Clavien-Dindo 4).
A total of 282 consecutive patients underwent MIEs during the study period. Of these, 138 (49%) developed at least one complication and 11 (4%) were classified as FTR. On univariable analysis, patients > 75 years of age or with cardiac comorbidities were 4 times more likely (OR 3.98, 95% CI 1.11-14.20, p = 0.033) and 4.7 times more likely (OR 4.70, 95% CI 1.19-18.58, p = 0.028) to experience FTR, respectively. Multivariable analysis revealed that age ≥ 75 years (OR 2.86, 95% CI 0.76-10.75, p = 0.120) and cardiac comorbidities (OR 3.75, 95% CI 0.91-15.50, p = 0.061) were associated with increased odds of FTR. Additionally, stratified univariable analysis among patients who developed life-threatening complications (Clavien-Dindo 4) showed no association with FTR.
Age and cardiac comorbidities are risk factors associated with FTR in patients undergoing MIE. These findings highlight the importance of preoperative risk stratification and optimization, as well as patient-provider shared decision-making, to reduce perioperative morbidity and mortality. Further studies are needed to develop perioperative strategies to reduce the rates of failure to rescue and improve the overall survival of this population.
探讨接受微创Ivor Lewis食管切除术（MIE）的患者中与抢救失败（FTR）相关的临床因素。
对2013年9月至2023年9月期间接受MIE的所有成年人（≥18岁）进行回顾性分析。FTR定义为发生任何术后并发症（任何Clavien-Dindo分级）的患者的死亡率。采用单变量逻辑回归确定哪些因素与FTR相关，p<0.05的显著因素纳入多变量模型。此外，进行分层分析以探讨发生危及生命并发症（Clavien-Dindo 4级）的患者中与FTR相关的因素。
在研究期间，共有282例连续患者接受了MIE。其中，138例（49%）发生了至少一种并发症，11例（4%）被归类为FTR。单变量分析显示，年龄>75岁或有心脏合并症的患者发生FTR的可能性分别高4倍（OR 3.98，95%CI 1.11-14.20，p=0.033）和4.7倍（OR 4.70，95%CI 1.19-18.58，p=0.028）。多变量分析显示，年龄≥75岁（OR 2.86，95%CI 0.76-10.75，p=0.120）和心脏合并症（OR 3.75，95%CI 0.91-15.50，p=0.061）与FTR几率增加相关。此外，对发生危及生命并发症（Clavien-Dindo 4级）的患者进行的分层单变量分析显示与FTR无关。
年龄和心脏合并症是接受MIE的患者中与FTR相关的危险因素。这些发现强调了术前风险分层和优化以及医患共同决策以降低围手术期发病率和死亡率的重要性。需要进一步研究制定围手术期策略以降低抢救失败率并改善该人群的总体生存率。
