Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer
Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer
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DOI：
10.1097/01.sla.0000143123.24556.1c
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发表时间：
2004-11-01
影响因子：
9
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Law, S;Wong, KH;Wong, J
目的：本研究旨在：(1)记录大容量中心食管切除术手术结果的演变，(2)确定肺部并发症和死亡率的预测因素，(3)检查术前放化疗是否会使术后恢复复杂化。背景资料：食管切除术后肺部并发症和死亡率仍然很高，相关因素尚未得到充分研究。新辅助放化疗被广泛应用；据推测，这可能导致不良的术后结果。方法：前瞻性分析421例行切除术的胸内鳞状细胞食管癌患者的预后。Logistic回归分析确定了肺部并发症和死亡的独立预测因子。比较了两个时期：第一阶段（1990年1月至1995年6月）和第二阶段（1995年7月至2001年12月）。在后期，引入了新辅助放化疗。结果：83%的患者进行了经胸切除。在II期，42%的患者接受了新辅助放化疗。主要肺部并发症发生率为15.9%，占医院死亡的55%。30天死亡率和住院死亡率分别为1.4%和4.8%。Logistic回归分析发现，年龄、手术时间和肿瘤近端位置是肺部并发症的危险因素，而高龄和失血过多是死亡率的预测因素。放化疗没有导致更坏的结果。比较第一阶段和第二阶段时，住院死亡率从7.8%降至1.1%,P = 0.001，相应的失血量也减少（中位失血量为700毫升（范围：200-2700（第一阶段））和450毫升（范围：100-7000）（第二阶段），P < 0.01）。结论：在研究期间的最后6年，死亡率为1%。术前放化疗没有导致更差的结果。死亡率的降低与出血量的减少相关。结论：在最后6年的研究期间，死亡率达到1.1%。术前放化疗没有导致更差的结果。死亡率的降低与出血量的减少相关。
Objective: This study aimed at: (1) documenting the evolution of surgical results of esophagectomy in a high-volume center, (2) identifying predictive factors of pulmonary complications and mortality, and (3) examining whether preoperative chemoradiation therapy would complicate postoperative recovery.Summary Background Data: Pulmonary complications and mortality rate after esophagectomy remain substantial, and factors responsible have not been adequately studied. Neoadjuvant chemoradiation is widely used; it is hypothesized that this may lead to adverse postoperative outcome.Methods: Prospectively collected data were used to analyze outcome in 421 patients with intrathoracic squamous cell esophageal cancer who underwent resection. Logistic regression analyses determined independent predictors of pulmonary complications and death. Two time periods were compared: period I (January 1990 to June 1995) and period II (July 1995 to December 2001). In the later period, neoadjuvant chemoradiation therapy was introduced.Results: Transthoracic resections were carried out in 83% of patients. Neoadjuvant chemoradiation was given to 42% of patients in period II. Major pulmonary complications occurred in 15.9%, and were primarily responsible for 55% of hospital deaths. Thirty-day and hospital mortality rates were 1.4% and 4.8%, respectively. Logistic regression analysis identified age, operation duration, and proximal tumor location as risk factors for pulmonary complications, whereas advanced age and higher blood loss were predictive of mortality. Chemoradiation did not lead to worse outcome. When period I and II were compared, hospital mortality rate reduced from 7.8% to 1.1%, P = 0.001, with correspondingly less blood loss (median blood loss was 700 ml (range: 200-2700 (period I) and 450 ml (range: 100-7000) (period II), P < 0.01). Conclusion: A I.1% mortality rate was achieved in the last 6 years of the study period. Preoperative chemoradiation did not result in worse outcome. Reduction in mortality rate correlated with decreased blood loss.Conclusion: A 1.1% mortality rate was achieved in the last 6 years of the study period. Preoperative chemoradiation did not result in worse outcome. Reduction in mortality rate correlated with decreased blood loss.