Prognostic Impact of Postoperative Complications in 502 Patients With Surgically Resected Esophageal Squamous Cell Carcinoma A Retrospective Single-institution Study
Prognostic Impact of Postoperative Complications in 502 Patients With Surgically Resected Esophageal Squamous Cell Carcinoma A Retrospective Single-institution Study
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DOI：
10.1097/sla.0000000000001510
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发表时间：
2016-08-01
影响因子：
9
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Baba, Yoshifumi;Yoshida, Naoya;Baba, Hideo
目的：探讨食管鳞状细胞癌（ESCC）手术切除患者术后并发症与长期生存的关系。背景资料：食管切除术是ESCC根治性治疗的主要方法；然而，这种复杂的手术有很高的术后发病率和死亡率。术后并发症对此类患者长期生存的影响仍存在争议。方法：本回顾性单机构研究纳入了502例连续行ESCC切除术的患者。采用Cox比例风险模型计算死亡率的风险比（HR）。结果：217例（43%）患者出现术后并发症（>= Clavien-Dindo分级2级）。总的来说，术后并发症没有影响这些患者的长期临床结果。然而，有肺并发症的患者的总生存期比无肺并发症的患者差[log rank P = 0.0002；单因素HR = 1.51, 95%可信区间（CI） 1.20 ~ 1.88, P = 0.0006；多变量HR = 1.60, 95% CI 1.05 ~ 2.38, P = 0.029]。肺部并发症的影响未因临床或病理特征而明显改变（所有评估的相互作用P < 0.05）。此外，术后乳糜胸也与较差的总生存期相关（log rank P = 0.0021），而手术部位感染、复发性神经麻痹、心血管并发症和吻合口漏与总生存期无关。结论：术后肺部并发症可能是escc切除术患者较差长期生存的独立预测因素。
Objective: To investigate the relationship between postoperative complications and long-term survival in patients with surgically resected esophageal squamous cell carcinoma (ESCC).Summary Background Data: Esophagectomy is the mainstay of curative treatment for ESCC; however, this complex procedure has high risks of postoperative morbidity and mortality. The impact of postoperative complications on long-term survival of such patients remains controversial.Methods: This retrospective single institution study included 502 consecutive patients who had undergone resection of ESCC. The Cox proportional hazard model was used to compute the hazard ratio (HR) for mortality.Results: Postoperative complications (>= Clavien-Dindo classification grade 2) occurred in 217 patients (43%). Overall, postoperative complications did not affect long-term clinical outcomes of these patients. However, patients with pulmonary complications had worse overall survival than those without pulmonary complications [log rank P = 0.0002; univariate HR = 1.51, 95% confidence interval (CI) 1.20-1.88, P = 0.0006; multivariate HR = 1.60, 95% CI 1.05-2.38, P = 0.029]. The effect of pulmonary complications was not significantly modified by clinical or pathological features (P for all assessed interactions >0.05). In addition, postoperative chylothorax was also associated with poor overall survival (log rank P = 0.0021), whereas surgical site infection, recurrent nerve paralysis, cardiovascular complication, and anastomotic leakage were not.Conclusions: Postoperative pulmonary complications may be an independent predictor of poorer long-term survival in patients undergoing resection of ESCCs.