The influence of technical complications on postoperative outcome and survival after esophagectomy
The influence of technical complications on postoperative outcome and survival after esophagectomy
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DOI：
10.1245/aso.2006.04.040
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发表时间：
2006-04-01
影响因子：
3.7
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Ferri, LE;Law, S;Wong, J
工作背景：与食管癌切除术相关的生存率令人沮丧，这导致了对这种不良预后的潜在可纠正因素的研究。虽然这是直观的技术并发症可能会增加术后死亡率，对长期生存的影响是有争议的。方法：从1990年至2002年，434例患者进行切除胸内食管鳞状细胞癌。审查了Propionic收集的数据，以确定是否存在技术并发症。比较有技术并发症和无技术并发症的患者之间的患者、肿瘤和手术变量、术后结局和生存率。结果：98例（22.6%）患者发生技术并发症。有技术并发症的患者心脏病的患病率更高，近端肿瘤更多，颈椎病更多。技术并发症与肺部并发症发生率增加（37.8% vs. 10.7%; P < .001）和住院死亡率增加（9.2% vs. 3.3%; P = .025）相关，但30天死亡率无差异（2% vs. 1.2%; P = .6）。生存预后不良的因素包括男性，III/IV期疾病，肝硬化，近端肿瘤，R1/R2切除术，但不是技术complications.Conclusions：虽然术后即刻结果和住院死亡率增加，没有影响长期生存的并发症相关的手术技术错误的患者。
Background: The dismal survival associated with esophagectomy for cancer has led to the search for potentially correctable factors responsible for this poor prognosis. Although it is intuitive that technical complications could increase postoperative mortality, the effect on long-term survival is controversial.Methods: From 1990 to 2002, 434 patients underwent resection for squamous cell carcinoma of the intrathoracic esophagus. Prospectively collected data were reviewed for the presence of technical complications. Patient, tumor, and operative variables, postoperative outcome, and survival were compared between patients with technical complications and those without. Prognostic factors were assessed by multivariate analysis.Results: Technical complications occurred in 98 (22.6%) patients. Patients with technical complications had a higher prevalence of cardiac disease, more proximal tumors, and more cervical anastomoses. Technical complications were associated with an increased rate of pulmonary complications (37.8% vs. 10.7%; P < .001) and increased hospital mortality (9.2% vs. 3.3%; P = .025), but no difference in 30-day mortality (2% vs. 1.2%; P = .6). Poor-prognostic factors for survival included male sex, stage III/IV disease, cirrhosis, proximal tumors, and R1/R2 resection, but not technical complications.Conclusions: Although immediate postoperative outcome and hospital mortality rates were increased, no effect on long-term survival was seen in patients with complications related to errors in surgical technique.