Minimally invasive esophagectomy may contribute to low incidence of postoperative surgical site infection in patients with poor glycemic control
Minimally invasive esophagectomy may contribute to low incidence of postoperative surgical site infection in patients with poor glycemic control
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微创食管切除术可能有助于降低血糖控制不佳患者术后手术部位感染的发生率
DOI：
10.1007/s00423-021-02306-6
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Baba Hideo
中科院分区：
文献类型：
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作者：
Yamane Taishi;Yoshida Naoya;Horinouchi Tomo;Morinaga Takeshi;Eto Kojiro;Harada Kazuto;Ogawa Katsuhiro;Sawayama Hiroshi;Iwatsuki Masaaki;Baba Yoshifumi;Miyamoto Yuji;Baba Hideo
目的术前高糖化血红蛋白（HbA1c）水平被认为会增加食管切除术后的并发症。微创食管切除术（MIE）比开放式食管切除术（OE）侵入性小，可减少术后并发症。然而，尚不清楚MIE是否有助于术前高HbA1c水平患者的低发病率。因此，本研究旨在阐明术前HbA1c水平对OE和MIE术后并发症发生率的影响。方法回顾性分析2005年4月~ 2020年4月食管癌行OE治疗的280例患者和行MIE治疗的304例患者。OE组和MIE组根据术前HbA1c水平（< 6.9%,≥6.9%）进一步分为两组。结果HbA1c水平高的患者术后手术部位感染（ssi）发生率显著高于其他患者（P= 0.0048）。多因素分析显示，高HbA1c水平是OE术后频繁发生ssi的独立危险因素（风险比2.52；95%可信区间1.101 - 5.739；P= 0.029）。相反，高HbA1c水平不影响MIE后SSI的发生率（P= 1.00）。高HbA1c水平与OE和MIE后SSI以外的其他发病率无关。结论术前高糖化血红蛋白水平显著增加OE术后SSI风险，而MIE术后无显著升高。提示，即使术前血糖控制较差的患者，MIE的低侵袭性也可能导致SSI的低发生率。
PurposeHigh preoperative hemoglobin A1c (HbA1c) levels have been suggested to increase complications after esophagectomy. Minimally invasive esophagectomy (MIE) is less invasive than open esophagectomy (OE) and may reduce postoperative complications. However, it has not been established whether MIE contributes to low morbidity in patients with high preoperative HbA1c levels. Thus, the current study aimed to elucidate the effect of preoperative HbA1c levels on the incidence of complications each after OE and MIE.MethodsA total of 280 patients who underwent OE and 304 patients who underwent MIE for esophageal cancer between April 2005 and April 2020 were retrospectively analyzed. The OE and MIE groups were further divided into two groups according to their preoperative HbA1c levels (< 6.9%, ≥ 6.9%).ResultsPatients with high HbA1c levels had a significantly higher incidence of surgical site infections (SSIs) after OE (P= 0.0048). Multivariate analysis demonstrated that a high HbA1c level was an independent risk factor for frequent SSIs after OE (hazard ratio 2.52; 95% confidence interval, 1.101– 5.739;P= 0.029). On the contrary, a high HbA1c level did not affect the incidence of SSI after MIE (P= 1.00). A high HbA1c level was not associated with the incidence of morbidities other than SSI after OE and MIE.ConclusionsA high preoperative HbA1c level significantly increased SSI risk after OE but not after MIE. It was suggested that lower invasiveness of MIE could contribute to a low incidence of SSI, even in patients with poor preoperative glycemic control.