A 25 mm Circular Stapler Anastomosis Is Associated with Higher Anastomotic Leakage Rates Following Minimally Invasive Ivor Lewis Operation
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Patients
2.3. Outcome Measures and Definitions
2.4. Surgical Techniques
2.4.1. Anastomotic Techniques
2.4.2. Postoperative Management
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Morbidity and Mortality
3.3. Univariate Analysis/Multivariate Analysis
3.4. Subgroup Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | SS (n = 65) | LS (n = 54) | p |
---|---|---|---|
Male sex, n (%) | 50 (76.9) | 49 (88.9) | 0.088 |
Median age at resection, years (range) | 63.5 (39–84) | 65.8 (44–81) | 0.239 |
Median BMI, kg/m2 (range) | 28.0 (18–43) | 26.3 (16-51) | 0.235 |
Tumour location, n (%) | 0.470 | ||
Oesophagus | 33 (50.8) | 31 (57.4) | |
GEJ | 32 (49.2) | 23 (42.6) | |
Comorbidities | |||
Diabetes, n (%) | 10 (15.4) | 6 (11.1) | 0.496 |
Cardiovascular disease, n (%) | 39 (52.7) | 37 (64.8) | 0.59 |
Pulmonary disease, n (%) | 13 (20.0) | 9 (16.7) | 0.641 |
Renal insufficiency, n (%) | 6 (9.2) | 5 (9.3) | 0.996 |
ASA physical status, n (%) | 0.497 | ||
I | 1 (1.6) | 2 (4.0) | |
II | 26 (41.3) | 16 (32.0) | |
III | 35 (55.6) | 32 (64.0) | |
IV | 1 (1.6) | 0 (0.0) | |
Preoperative chemotherapy, n (%) | 55 (84.6) | 50 (92.6) | 0.179 |
Preoperative radiotherapy, n (%) | 23 (35.9) | 16 (30.2) | 0.511 |
UICC stage, n (%) | 0.773 | ||
I | 7 (11.5) | 3 (6.1) | |
II | 16 (26.2) | 12 (24.5) | |
III | 35 (57.4) | 31 (63.3) | |
IV | 3 (4.9) | 3 (6.1) | |
Histologic type, n (%) | 0.042 | ||
AC | 43 (68.3) | 44 (84.6) | |
SCC | 20 (31.7) | 8 (15.4) |
Characteristic | SS (n = 65) | LS (n = 54) | p |
---|---|---|---|
Median duration of resection (range), min | 442.5 (306–631) | 429.7 (254–561) | 0.357 |
Median duration of hospital stay (range), days | 26.6 (10–103) | 22.9 (9–261) | 0.477 |
Postoperative morbidity, n (%) | 49 (75.4) | 35 (67.3) | 0.335 |
Major postoperative morbidity, n (%) | 41 (63.1) | 19 (35.2) | 0.002 |
Anastomotic leak, n (%) | 12 (18.5) | 2 (3.7) | 0.013 |
Anastomotic stricture within 90 days, n (%) | 1 (1.6%) | 4 (7.4.3) | 0.175 |
Pyloric stenosis, n (%) | 18 (27.7) | 10 (18.9) | 0.262 |
Pulmonary complications, n (%) | 33 (50.8) | 23 (42.6) | 0.374 |
Postoperative pneumonia, n (%) | 23 (35.4) | 14 (25.9) | 0.267 |
30-day mortality, n (%) | 1 (1.6) | 0 (0) | 1 |
90-day mortality, n (%) | 4 (7.3) | 1 (2.9) | 0.389 |
Characteristic | AL (n = 14) | UV p | MV † | |
---|---|---|---|---|
p | HR (95% CI) | |||
Male sex, n (%) | 12 (85.7) | 0.726 | ||
Age > 65 years, n (%) | 7 (50.0) | 0.920 | ||
BMI > 30 kg/m2, n (%) | 4 (28.6) | 0.343 | ||
Tumour location, n (%) | 0.157 | |||
Oesophagus | 5 (35.7) | |||
GEJ | 9 (64.3) | |||
Diabetes, n (%) | 3 (21.4) | 0.358 | ||
Cardiovascular disease, n (%) | 12 (85.7) | 0.071 | 0.070 | 0.474 (0.211–1.064) |
Pulmonary disease, n (%) | 5 (35.7) | 0.087 | ||
Renal insufficiency, n (%) | 3 (21.4) | 0.110 | ||
Preoperative chemotherapy, n (%) | 13 (92.9) | 0.573 | ||
Preoperative radiotherapy, n (%) | 5 (35.7) | 0.840 | ||
Histologic type, n (%) | 0.568 | |||
AC | 11 (79) | |||
SCC | 3 (21) | |||
Stapler diameter, n (%) | 0.025 | 0.029 | 2.435 (1.093–5.426) | |
25 mm | 9 (69.2) | |||
29 mm | 4 (30.8) | |||
Pulmonary complications, n (%) | 12 (85.7) | 0.007 | 0.012 | 0.360 (0.163–0.796) |
Pneumonia, n (%) | 9 (64.3) | 0.008 |
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Hofmann, T.; Biebl, M.; Knitter, S.; Fehrenbach, U.; Chopra, S.; Cetinkaya-Hosgor, C.; Raakow, J.; Seika, P.; Langer, R.; Pratschke, J.; et al. A 25 mm Circular Stapler Anastomosis Is Associated with Higher Anastomotic Leakage Rates Following Minimally Invasive Ivor Lewis Operation. J. Clin. Med. 2022, 11, 7177. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11237177
Hofmann T, Biebl M, Knitter S, Fehrenbach U, Chopra S, Cetinkaya-Hosgor C, Raakow J, Seika P, Langer R, Pratschke J, et al. A 25 mm Circular Stapler Anastomosis Is Associated with Higher Anastomotic Leakage Rates Following Minimally Invasive Ivor Lewis Operation. Journal of Clinical Medicine. 2022; 11(23):7177. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11237177
Chicago/Turabian StyleHofmann, Tobias, Matthias Biebl, Sebastian Knitter, Uli Fehrenbach, Sascha Chopra, Candan Cetinkaya-Hosgor, Jonas Raakow, Philippa Seika, Rupert Langer, Johann Pratschke, and et al. 2022. "A 25 mm Circular Stapler Anastomosis Is Associated with Higher Anastomotic Leakage Rates Following Minimally Invasive Ivor Lewis Operation" Journal of Clinical Medicine 11, no. 23: 7177. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11237177