Long-Term Survival After Complications Following Major Abdominal Surgery.
Long-Term Survival After Complications Following Major Abdominal Surgery.
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DOI：
10.1007/s11605-016-3084-4
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
van der Peet DL
中科院分区：
文献类型：
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作者：
Straatman J;Cuesta MA;de Lange-de Klerk ES;van der Peet DL
术后并发症与心脏、骨科和血管手术的长期生存率降低有关。对于腹部大手术研究，在较小的研究中报告了相互矛盾的证据。本研究的目的是评估腹部大手术并发症对长期生存的影响。对2009年1月至2014年3月期间接受腹部大手术的861例连续患者进行了一项观察性队列研究，并对生存状态进行了前瞻性评估。评估术后并发症对生存率的影响。术后并发症与生存率降低相关，即使在应用30天死亡率校正后（p < 0.001）。分层考克斯回归分析显示，术后并发症是上消化道和女性肝胰胆管患者生存的重要预测因素。对年龄、性别、BMI、阿萨分级、激进性和阳性淋巴结状态进行校正。这些结果进一步表明预防和早期诊断和治疗并发症的重要性。病因学因素被认为是持续水平的炎性标志物，以及恶性肿瘤中减弱的免疫应答与随后的癌细胞接种。未来的研究应致力于预防和早期诊断术后并发症，以防止发病率和死亡率不仅在术后早期阶段，而且在长期。
Postoperative complications have been associated with decreased long-term survival in cardiac, orthopedic, and vascular surgery. For major abdominal surgery research, conflicting evidence is reported in smaller studies. The aim of this study was to assess the effect of complications on long-term survival in major abdominal surgery. An observational cohort study was conducted of 861 consecutive patients that underwent major abdominal surgery between January 2009 and March 2014, with prospective assessment of the survival status. The effect of postoperative complications on survival was assessed. Postoperative complications were associated with decreased survival, even after applying correction for 30-day mortality (p < 0.001). Stratified Cox regression analysis depicted postoperative complications to be an important predictor for survival in upper gastrointestinal and female hepatopancreaticobiliary patients. Correction was applied for age, gender, BMI, ASA classification, radicality, and positive lymph node status. These results further indicate the importance of prevention and early diagnosis and treatment of complications. Etiological factors are believed to be both sustained levels of inflammatory markers, as well as attenuated immune response in malignancy with subsequent cancer cell seeding. Future research should aim to prevent and early diagnose postoperative complications to prevent morbidity and mortality not only in the early postoperative phase, but also in the long term.