Abstract：
BACKGROUND: Anastomotic leakage (AL) is one of the most critical postoperative complications after subtotal esophagectomy in patients with esophageal cancer. This study attempted to develop an optimal scoring system for stratifying the risk for AL.
METHODS: The study included 171 patients who underwent subtotal esophagectomy for esophageal cancer followed by esophagogastrostomy in the cervical region from January 2011 to April 2021 at Nagoya University Hospital. AL was defined by radiologic or endoscopic evidence of anastomotic breakdown using some modalities. A risk scoring system for an early diagnosis of AL was established using factors determined in the multivariate analysis. A score was calculated for each patient, and the patients were classified into three categories according to the risk for AL: low-, intermediate- and high-risk. The trend of the risk for AL among the categories was evaluated.
RESULTS: Twenty-nine patients (17%) developed AL. Multivariate analysis demonstrated that sinistrous gross features of drain fluid (P < 0.001; odds ratio (OR), 10.2), radiologic air bubble sign (P < 0.001; OR, 15.0) and the level of drain amylase ≥280 U/L on postoperative Day 7 (P < 0.001; OR, 9.0) were significantly associated with AL. According to the matching number of the above three risk factors and categorization into three risk groups, the incidence of AL was 6.1% (8/131) in the low-risk group, 45.5% (15/33) in the intermediate-risk group and 85.7% (6/7) in the high-risk group (area under curve, 0.81; 95% confidence interval, 0.72-0.90).
CONCLUSIONS: The present AL-risk scoring system may be useful in postoperative patient care after subtotal esophagectomy.
METHODS: The study included 171 patients who underwent subtotal esophagectomy for esophageal cancer followed by esophagogastrostomy in the cervical region from January 2011 to April 2021 at Nagoya University Hospital. AL was defined by radiologic or endoscopic evidence of anastomotic breakdown using some modalities. A risk scoring system for an early diagnosis of AL was established using factors determined in the multivariate analysis. A score was calculated for each patient, and the patients were classified into three categories according to the risk for AL: low-, intermediate- and high-risk. The trend of the risk for AL among the categories was evaluated.
RESULTS: Twenty-nine patients (17%) developed AL. Multivariate analysis demonstrated that sinistrous gross features of drain fluid (P < 0.001; odds ratio (OR), 10.2), radiologic air bubble sign (P < 0.001; OR, 15.0) and the level of drain amylase ≥280 U/L on postoperative Day 7 (P < 0.001; OR, 9.0) were significantly associated with AL. According to the matching number of the above three risk factors and categorization into three risk groups, the incidence of AL was 6.1% (8/131) in the low-risk group, 45.5% (15/33) in the intermediate-risk group and 85.7% (6/7) in the high-risk group (area under curve, 0.81; 95% confidence interval, 0.72-0.90).
CONCLUSIONS: The present AL-risk scoring system may be useful in postoperative patient care after subtotal esophagectomy.
摘要：
背景：吻合口漏（AL）是食管癌患者食管次全切除术后最严重的术后并发症之一。本研究试图开发一种最佳评分系统，以对AL的风险进行分层。
方法：本研究纳入了从2011年1月至2021年4月在名古屋大学医院接受食道癌次全食管切除术后颈部食管胃吻合术的171例患者。使用某些方式，通过放射学或内窥镜检查吻合口破裂的证据来定义AL。使用多变量分析中确定的因素建立了早期诊断AL的风险评分系统。计算每个病人的分数，根据AL的风险将患者分为三类：低，中等风险和高风险。评估了类别中AL的风险趋势。
结果：29例患者（17%）发展为AL。多变量分析表明，引流液的总体特征（P<0.001；比值比（OR），10.2),放射性气泡征(P<0.001；OR，15.0）和术后第7天的引流淀粉酶水平≥280U/L（P<0.001；OR，9.0)与AL显著相关。根据以上三个风险因素的匹配数,将其分为三个风险组,低危组AL的发生率为6.1%(8/131),中危组的45.5％（15/33）和高风险组的85.7％（6/7）（曲线下面积，0.81；95%置信区间，0.72-0.90）。
结论：目前的AL风险评分系统可能对食管次全切除术后的患者护理有用。
方法：本研究纳入了从2011年1月至2021年4月在名古屋大学医院接受食道癌次全食管切除术后颈部食管胃吻合术的171例患者。使用某些方式，通过放射学或内窥镜检查吻合口破裂的证据来定义AL。使用多变量分析中确定的因素建立了早期诊断AL的风险评分系统。计算每个病人的分数，根据AL的风险将患者分为三类：低，中等风险和高风险。评估了类别中AL的风险趋势。
结果：29例患者（17%）发展为AL。多变量分析表明，引流液的总体特征（P<0.001；比值比（OR），10.2),放射性气泡征(P<0.001；OR，15.0）和术后第7天的引流淀粉酶水平≥280U/L（P<0.001；OR，9.0)与AL显著相关。根据以上三个风险因素的匹配数,将其分为三个风险组,低危组AL的发生率为6.1%(8/131),中危组的45.5％（15/33）和高风险组的85.7％（6/7）（曲线下面积，0.81；95%置信区间，0.72-0.90）。
结论：目前的AL风险评分系统可能对食管次全切除术后的患者护理有用。
