Benchmarking Complications Associated With Esophagectomy
Benchmarking Complications Associated With Esophagectomy
复制标题
DOI：
10.1097/sla.0000000000002611
复制
发表时间：
2019-02-01
影响因子：
9
通讯作者：
Wijnhoven, B. P. L.
中科院分区：
文献类型：
--
作者：
Low, Donald E.;Kuppusamy, Madhan Kumar;Wijnhoven, B. P. L.
目的：利用具有特定定义的标准化数据集，前瞻性地收集国际数据，为食管切除术相关的并发症和结局提供基准。背景资料概要：肿瘤手术的结局报告缺乏标准化的手术结果报告系统，特别是并发症。这是特别的情况下，食管切除术影响的准确性和相关性的国际结果评估，临床试验结果，和质量改进projects.Methods：食管并发症共识组（ECCG），涉及24个高容量的食管外科中心在14个国家制定了一个标准化的平台，用于记录并发症和质量措施与食管切除术。使用安全的在线数据库（ESODA-TA.org），ECCG中心根据ECCG平台前瞻性地记录了这些中心2年内所有切除术的数据。结果：2015年1月至2016年12月期间，共有2704例切除术输入数据库。所有人口统计学和随访数据字段均100%完整。大多数手术是癌症（95.6%），通常位于食管远端（56.2%）。新辅助放化疗1192例（46.1%），新辅助化疗763例（29.5%）。手术入路以开放手术为主，占52.1%，微创手术占47.9%。最常见的是胸部切除术（60.7%），93.4%的患者完成了RO切除术。并发症的总体发生率为59%，最常见的个体并发症为肺炎（14.6%）和房性心律失常（14.5%）。吻合口漏、导管坏死、乳糜漏和返神经损伤的发生率分别为11.4%、1.3%、4.7%和4.2%。17.2%的患者发生Clavien-Dindo并发症>= IIIb。再入院发生在11.2%的情况下，30和90天的死亡率分别为2.4%和4.5%.Conclusion：标准化的方法提供了当代国际基准食管切除术后的报告结果。
Objective: Utilizing a standardized dataset with specific definitions to prospectively collect international data to provide a benchmark for complications and outcomes associated with esophagectomy.Summary of Background Data: Outcome reporting in oncologic surgery has suffered from the lack of a standardized system for reporting operative results particularly complications. This is particularly the case for esophagectomy affecting the accuracy and relevance of international outcome assessments, clinical trial results, and quality improvement projects.Methods: The Esophageal Complications Consensus Group (ECCG) involving 24 high-volume esophageal surgical centers in 14 countries developed a standardized platform for recording complications and quality measures associated with esophagectomy. Using a secure online database (ESODA-TA.org ), ECCG centers prospectively recorded data on all resections according to the ECCG platform from these centers over a 2-year period.Results: Between January 2015 and December 2016, 2704 resections were entered into the database. All demographic and follow-up data fields were 100% complete. The majority of operations were for cancer (95.6%) and typically located in the distal esophagus (56.2%). Some 1192 patients received neoadjuvant chemoradiation (46.1%) and 763 neoadjuvant chemotherapy (29.5%). Surgical approach involved open procedures in 52.1% and minimally invasive operations in 47.9%. Chest anastomoses were done most commonly (60.7%) and RO resections were accomplished in 93.4% of patients. The overall incidence of complications was 59% with the most common individual complications being pneumonia (14.6%) and atrial dysrhythmia (14.5%). Anastomotic leak, conduit necrosis, chyle leaks, recurrent nerve injury occurred in 11.4%, 1.3%, 4.7%, and 4.2% of cases, respectively. Clavien-Dindo complications >= IIIb occurred in 17.2% of patients. Readmissions occurred in 11.2% of cases and 30- and 90-day mortality was 2.4% and 4.5%, respectively.Conclusion: Standardized methods provide contemporary international benchmarks for reporting outcomes after esophagectomy.