Clinical Outcomes of Preserving Bronchial Arteries During Radical Esophagectomy: A Propensity-Score Matched Analysis.

Autor: Fujisawa K; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan. fkentoku@gmail.com., Ohkura Y; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan., Ueno M; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan., Ogawa Y; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan., Shimoyama H; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan., Haruta S; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan., Udagawa H; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Feb; Vol. 31 (2), pp. 827-837. Date of Electronic Publication: 2023 Oct 26.
DOI: 10.1245/s10434-023-14495-z
Abstrakt: Background: Postoperative pneumonia is a common and major cause of mortality after radical esophagectomy. Intraoperative preservation of the bronchial arteries is often aimed at avoiding tracheobronchial ischemia; however, it is unknown whether this contributes to a reduction in postoperative pneumonia.
Patients and Methods: We enrolled 348 consecutive patients who underwent radical esophagectomy for esophageal cancer at Toranomon Hospital from January 2011 to July 2018. We classified patients into a bronchial artery-resected (BA-R) group (n = 93) and a bronchial artery-preserved (BA-P) group (n = 255) and compared the incidence of postoperative pneumonia between the two groups. A propensity score-matching analysis for bronchial artery preservation versus resection was performed.
Results: Overall, 182 patients were matched. Univariate analysis of the propensity score-matched groups showed that Brinkman index ≥ 400, vital capacity (%VC) < 80%, and bronchial artery resection were associated with the development of postoperative pneumonia. Multivariate analysis revealed three significant factors associated with postoperative pneumonia: Brinkman index ≥ 400 [p = 0.006, odds ratio (HR) 3.302, 95% confidence interval (95% CI) 1.399-7.790], %VC < 80% (p = 0.034, HR 6.365, 95% CI 1.151-35.205), and bronchial artery resection (p = 0.034, HR 2.131, 95% CI 1.060-4.282). The incidence of postoperative complications (CD grade III) was higher in the BA-R group (BA-R 42.8% versus BA-P 27.5%, p = 0.030). There was no significant difference in overall survival between the two groups at 5 years (BA-R 63.1% versus BA-P 72.1%, p = 0.130).
Conclusion: Preserving the bronchial artery is associated with a decreased incidence of postoperative pneumonia.
(© 2023. Society of Surgical Oncology.)
Databáze: MEDLINE
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