Prehabilitation Reduces Occurrence of Anastomotic Leaks After Esophagectomy-A Retrospective Cohort Analysis and Meta-analysis.

IF 1.6 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2025-06-11 DOI:10.1007/s12029-025-01213-z

Alissa Jell, Alexandra Dusi, Marcus Feith, Jeannine Bachmann, Dirk Wilhelm, Marc Martignoni, Ekin Ihsan Demir, Helmut Friess, Stephan Schorn

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引用次数: 0

Abstract

Background: Esophageal anastomotic leaks (EAL) after esophagectomy strongly increase postoperative mortality and morbidity. Identifying, addressing, and improving risk factors are pivotal. In this article, we conducted a systematic review with meta-analysis, comparing findings with our 13-year experience in a German high-volume esophageal surgery center.

Methods: Databases of Pubmed, Scopus, and Cochrane were systematically screened for publications prior to 2025, and all patients undergoing esophageal resection surgery from 2010 to 2022 were analyzed for EAL occurrence, incorporating the review data into our analysis.

Results: Among 14,163 studies screened, 202 were included, with 123 studies providing sufficient information on risk factors' impact on EAL. Our patient register revealed 144 out of 787 with EAL. Cardiopulmonary factors such as hypertension (RR 1.44; p = 0.0004), coronary artery disease (RR 1.28; p = 0.0004), heart insufficiency (RR 1.56; p = 0.05), peripheral artery disease (RR 1.65; p = 0.0009), pulmonary disease (RR 1.5; p = 0.01), COPD (RR 1.39; p = 0.13), renal insufficiency (RR 1.61; p = 0.03), diabetes mellitus (RR 1.51; p < 0.00001), obesity (BMI > 25; RR 1.31; p = 0.009; BMI > 30; RR 1.49; p = 0.006), smoking (former smoker: RR 1.54; p < 0.0001; active smoker: RR 1.25; p < 0.0001), and frequent alcohol intake (RR 1.7; p = 0.003) were all associated with an increased risk of EAL following esophagectomy. We show that preoperative management targeting these risk factors result in a significant reduction of EAL.

Conclusion: Our extensive review underscores the critical role of cardiovascular, pulmonary, and renal conditions in EAL development, emphasizing the importance of prehabilitation to mitigate risks associated with EAL after esophagectomy.

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预适应减少食管切除术后吻合口瘘的发生——回顾性队列分析和荟萃分析。

背景：食管切除术后食管吻合口瘘（EAL）显著增加了术后死亡率和发病率。识别、处理和改善风险因素至关重要。在这篇文章中，我们进行了一项荟萃分析的系统回顾，将结果与我们在德国一家大容量食管手术中心13年的经验进行了比较。方法：系统筛选Pubmed、Scopus和Cochrane数据库中2025年之前的出版物，分析2010年至2022年所有接受食管切除术的患者的EAL发生情况，并将综述数据纳入我们的分析。结果：在筛选的14163项研究中，纳入202项研究，其中123项研究提供了足够的危险因素对EAL影响的信息。我们的患者记录显示787名患者中有144名患有EAL。高血压等心肺因素(RR 1.44；p = 0.0004)，冠状动脉疾病(RR 1.28；p = 0.0004)，心功能不全(RR 1.56；p = 0.05)，外周动脉疾病(RR 1.65；p = 0.0009)，肺部疾病(RR 1.5；p = 0.01), COPD (RR 1.39；p = 0.13)，肾功能不全(RR 1.61；p = 0.03)，糖尿病(RR 1.51；p < 0.00001)，肥胖(BMI bb25；RR 1.31;P = 0.009；Bmi bbbb30；RR 1.49;p = 0.006)，吸烟(前吸烟者：RR 1.54；P < 0.0001；主动吸烟者：RR 1.25；p < 0.0001)，频繁饮酒(RR 1.7；p = 0.003)均与食管切除术后EAL风险增加相关。我们发现针对这些危险因素的术前管理可显著减少EAL。结论：我们广泛的综述强调了心血管、肺部和肾脏疾病在EAL发展中的关键作用，强调了预适应对于减轻食管切除术后EAL相关风险的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.