SCI

22 April 2024

Early Interventional Treatment of High Output Chyle Leak following Esophagectomy is Associated with Improved Survival

(Annals of surgery;IF:9)

  • Deboever N, Correa AM, Feldman H, Eisenberg M, Antonoff MB, Mehran RJ, Rajaram R, Rice DC, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Hofstetter WL. Early Interventional Treatment of High Output Chyle Leak following Esophagectomy is Associated with Improved Survival. Ann Surg. 2024 Apr 4. doi: 10.1097/SLA.0000000000006266. Epub ahead of print. PMID: 38568206.
  • Corresponding author: 
    Wayne L. Hofstetter, MD, FACS 
    Professor and Deputy Chair, Department of Thoracic and Cardiovascular Surgery 
    University of Texas MD Anderson Cancer Center 
    1515 Holcombe Blvd, Houston, Texas, USA 77030 

    WHofstetter@MDAnderson.org 

    Phone: 713-563-0135 

    Fax: 713-794-4901 

Objectives 目标

Our objective was to investigate overall survival (OS) and length of stay (LOS) associated with differing management for high output (>1 liter over 24 h) leaks (HOCL) following cancer related esophagectomy.

我们的目标是研究癌症相关食管切除术后高输出性（24小时内超过1升）乳糜漏出（HOCL）的不同管理方式与总生存期（OS）和住院时间（LOS）的关联。

 

Summary background 背景摘要

Although infrequent, chyle leak following esophagectomy is an event that can lead to significant perioperative sequelae. Low volume leaks appear to respond to non-operative measures, while HOCL often require invasive therapeutic interventions.

虽然不常见，食管切除术后的乳糜漏是一种可能导致重大围手术期后遗症的事件。少量的乳糜漏出似乎可以通过非手术措施得到控制，而高输出性乳糜漏出（HOCL）通常需要侵入性治疗干预。

 

Methods 方法

From a prospective single-institution database, we retrospectively reviewed patients treated from 2001-2021 who underwent esophagectomy for esophageal cancer. Within that cohort, we focused on a subgroup of patients who manifested a HOCL postoperatively. Clinicopathologic and operative characteristics were collected, including hospital length of stay and survival data.

我们从一个前瞻性单一机构数据库中回顾性地审查了2001年至2021年间接受食管癌食管切除术治疗的患者。在这一队列中，我们重点关注了术后出现高输出性乳糜漏出（HOCL）的患者亚组。收集了临床病理和手术特征数据，包括住院时间和生存数据。

 

Results 结果

A total of 53/2299 patients manifested a HOCL. These were mostly males (77%), with a mean age of 62 years. Of this group, 15 patients received non-operative management, 15 patients received prompt (<72 h from diagnosis) interventional management, and 23 received late interventional management. Patients in the late intervention group had longer length of stay compared to early intervention (Slope=9.849, 95% Confidence Interval [CI] 3.431 to 16.267). Late intervention (Hazard Ratio (HR) 4.772, CI: 1.384 to 16.460) and non-operative management (HR 4.731, CI: 1.294 to 17.305) were associated with increased mortality compared to early intervention. Patients with early intervention for HOCL had an overall survival similar to patients without chyle leaks in survival analysis.

共有53/2299名患者表现出高输出性乳糜漏出（HOCL）。这些患者主要是男性（77%），平均年龄为62岁。在这个组中，15名患者接受了非手术管理，15名患者接受了及时的介入管理（从诊断起<72小时），23名患者接受了晚期介入管理。与早期介入相比，晚期介入组的住院时间更长（斜率为9.849，95%置信区间[CI] 3.431至16.267）。与早期介入相比，晚期介入（风险比（HR）4.772，CI：1.384至16.460）和非手术管理（HR 4.731，CI：1.294至17.305）与死亡率增加相关。早期介入HOCL的患者在生存分析中的总生存期与未发生乳糜漏的患者相似。

 

Conclusions 结论

Patients with HOCL should receive early intervention in order to possibly reverse the prognostic implications of this potentially detrimental complication.

高输出性乳糜漏（HOCL）患者应尽早接受介入治疗，以可能逆转这一潜在有害并发症影响预后。

 

 

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