Risk factors for complications after esophageal cancer resection - A prospective population-based study in Sweden
Risk factors for complications after esophageal cancer resection - A prospective population-based study in Sweden
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DOI：
10.1097/01.sla.0000197698.17794.eb
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发表时间：
2006-02-01
影响因子：
9
通讯作者：
Lagergren, J
中科院分区：
文献类型：
--
作者：
Viklund, P;Lindblad, M;Lagergren, J
目的：为了确定食管或贲门癌切除术后并发症的危险因素，摘要背景资料：食管癌切除术后并发症的危险因素的知识是稀疏的，前瞻性的基于人群的研究是lacking.Methods：一个前瞻性的，全国性的，基于人群的研究进行了瑞典在2001年4月2日至2003年12月31日。从瑞典食管癌和贲门癌登记处前瞻性收集有关肿瘤特征和分期、外科手术和并发症的详细信息。对来自外科手术、组织病理学报告和重症监护室的医疗记录和特定图表进行了持续审查。多变量Logistic回归分析被用来估计相对危险度和95%的置信区间。结果：在275例接受手术切除食管或贲门癌，122（44%）至少有一个预定义的并发症。低手术量外科医生（每年< 5例手术）的术后吻合口瘘发生率高于高手术量外科医生（比值比，7.86; 95%置信区间，2.13-29.00）。手工缝合和吻合器吻合在吻合口漏的风险方面没有差异。在贲门癌患者中，与经腹部（仅腹部）入路相比，经胸入路导致更多的呼吸道并发症（比值比，4.78; 95%置信区间，1.66-13.76）。年龄较大，辅助肿瘤治疗，较高的术前出血量无显着增加并发症的风险，而没有影响的性别或肿瘤分期被发现。结论：高容量食管外科医生似乎降低吻合口瘘的风险。需要更多的大规模研究来确定我们研究中提出的其他潜在重要风险因素的作用。
Objective: To identify risk factors for complications after resection for esophageal or cardia cancer.Summary Background Data: Knowledge of risk factors for complications after esophageal resection for cancer is sparse, and prospective population-based studies are lacking.Methods: A prospective, nationwide, population-based study was conducted in Sweden in April 2, 2001 through December 31, 2003. Details about tumor characteristics and stage, surgical procedures, and complications were collected prospectively from the Swedish Esophageal and Cardia Cancer register. Medical records and specific charts from surgical procedures, histopathology reports, and intensive care units were continuously scrutinized. Multivariable logistic regression analyses were used to estimate relative risks and their 95% confidence intervals.Results: Among 275 patients undergoing surgical resection for esophageal or cardia cancer, 122 (44%) had at least one predefined complication. Operation by low-volume surgeons (< 5 operations annually) were followed by more anastomotic leakages than those by surgeons with higher volume (odds ratio, 7.86; 95% confidence interval, 2.13-29.00). Hand-sewn and stapled anastomoses did not differ regarding risk of anastomotic leakage. Among cardia cancer patients, transthoracic approach resulted in more respiratory complications compared with transhiatal (abdominal only) approach (odds ratio, 4.78; 95% confidence interval, 1.66-13.76). Older age, adjuvant oncologic therapy, and higher preoperative bleeding volume nonsignificantly increased the risks of complications, while no influence of sex or tumor stage was found.Conclusions: High-volume esophageal surgeons seem to lower the risk of anastomotic leakage. More large-scale studies are warranted to establish the roles of the other potentially important risk factors suggested in our study.