Population‐based study of anastomotic stricture rates after minimally invasive and open oesophagectomy for cancer
Autor: | Jarmo Gunn, Joonas H. Kauppila, Eero Sihvo, Ville Kytö, Olli Helminen, Jesper Lagergren |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty Esophageal Neoplasms medicine.medical_treatment Population lcsh:Surgery Constriction Pathologic Anastomosis Patient Readmission Medicine Upper GI Humans Minimally Invasive Surgical Procedures education Finland Aged Sweden education.field_of_study business.industry Proportional hazards model Incidence (epidemiology) Incidence Hazard ratio Anastomosis Surgical lcsh:RD1-811 General Medicine Original Articles Length of Stay Middle Aged Dilatation Confidence interval Surgery Esophagectomy Research Design Cohort Original Article Female business |
Zdroj: | BJS Open BJS Open, Vol 3, Iss 5, Pp 634-640 (2019) |
ISSN: | 2474-9842 |
Popis: | The population-based incidence of anastomotic stricture after minimally invasive oesophagectomy (MIO) and open oesophagectomy (OO) is not known. The aim of this study was to compare rates of anastomotic stricture requiring dilatation after the two approaches in an unselected cohort using nationwide data from Finland and Sweden.All patients who had MIO or OO for oesophageal cancer between 2007 and 2014 were identified from nationwide registries in Finland and Sweden. Outcomes were the overall rate of anastomotic stricture and need for single or repeated (3 or more) dilatations for stricture within the first year after surgery. Multivariable Cox regression provided hazard ratios (HRs) with 95 per cent confidence intervals, adjusted for age, sex, co-morbidity, histology, stage, year, country, hospital volume, length of hospital stay and readmissions.Some 239 patients underwent MIO and 1430 had an open procedure. The incidence of strictures requiring one dilatation was 16·7 per cent, and that for strictures requiring three or more dilatations was 6·6 per cent. The HR for strictures requiring one dilatation was not increased after MIO compared with that after OO (HR 1·19, 95 per cent c.i. 0·66 to 2·12), but was threefold higher for repeated dilatations (HR 3·25, 1·43 to 7·36). Of 18 strictures following MIO, 14 (78 per cent) occurred during the first 2 years after initiating this approach.The need for endoscopic anastomotic dilatation after oesophagectomy was common, and the need for repeated dilatation was higher after MIO than following OO. The increased risk after MIO may reflect a learning curve.Se desconoce la incidencia poblacional de estenosis anastomóticas tras esofaguectomía mínimamente invasiva (Todos los pacientes sometidos a MIO (La incidencia de estenosis que precisaron una dilatación fue del 16,7%, y del 6,6% para estenosis que precisaron ≥ 3 dilataciones. El HR de estenosis que requirieron una dilatación no se incrementó tras MIO en comparación con OO (HR 1,19, i.c. del 95% 0,66‐2,12), pero fue 3 veces más para dilataciones repetidas (≥ 3) (HR 3,25, i.c. del 95% 1,43‐7,36). De las 18 estenosis tras MIO, 14 (78%) ocurrieron durante los primeros dos años en los que se inició este abordaje.La necesidad de dilatación endoscópica de la anastomosis tras esofaguectomía fue frecuente y la necesidad de dilataciones repetidas fue más alta tras MIO en comparación con OO. El riesgo aumentado tras MIO puede deberse a la curva de aprendizaje. |
Databáze: | OpenAIRE |
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