Litao Yang1,2,3, Zhinuan Hong1,2,4, Zhiwei Lin1,2,4, Zhenyang Zhang5,6, Jiangbo Lin7,8, Mingduan Chen1,4, Xiaojie Yang1,2, Yukang Lin2, Wenwei Lin1,4, Jiafu Zhu1,2, Shuhan Xie1,2, Mingqiang Kang1,4. 1. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China. 2. Fujian Medical University, Fuzhou, 350001, China. 3. Department of Cardiothoracic Surgery, Baoji High-Tech Hospital, Baoji, 721013, China. 4. Fujian Provincial Key Laboratory of Thoracic and Cardiovascular Surgery, Fuzhou, 350001, China. 5. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China. 31368347@qq.com. 6. Fujian Provincial Key Laboratory of Thoracic and Cardiovascular Surgery, Fuzhou, 350001, China. 31368347@qq.com. 7. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China. deliver@fjmu.edu.cn. 8. Fujian Provincial Key Laboratory of Thoracic and Cardiovascular Surgery, Fuzhou, 350001, China. deliver@fjmu.edu.cn.
Abstract
BACKGROUND: Anastomotic mediastinal/pleural cavity leak (AMPCL) is a life-threatening postoperative complication after esophagectomy. The objective of this study was to find a safe and effective surgical method to reduce the incidence of AMPCL. METHODS: A total of 223 patients who underwent surgery in Fujian Medical University Union Hospital from May 2020 to October 2021 were enrolled in this study. Data for preoperative and postoperative test indices, postoperative complications, perioperative treatment were collected. After using 1:1 propensity score matching (PSM) to match two cohort (caliper = 0.1), the relationship between various factors and the incidence of AMPCL were analyzed. RESULTS: 209 patients were included for further analysis in the end. There were 95 patients in the sternocleidomastoid muscle flap embedding group (intervention group) and 114 in the routine operation group (control group). There was a significant difference in mean age between two groups. Gender, age, body mass index, diabetes, American society of anesthesiologists score, preoperative neoadjuvant therapy, pathological stage were included in performing 1:1 PSM, and there were no significant differences between two groups. Median operative time was significantly less in intervention group. Anastomotic leak (AL) did not present significant difference between two groups (8 [8.6] vs. 13 [14.0], p = 0.247), however, the AMPCL in intervention group was significantly lower than control group (0 [0] vs. 6 [6.5], p = 0.029). CONCLUSIONS: The sternocleidomastoid muscle flap embedding could significantly reduce the incidence of AMPCL. This additional procedure is safe, and effective without increase in the occurrence of postoperative complications and hospital expenses.
BACKGROUND: Anastomotic mediastinal/pleural cavity leak (AMPCL) is a life-threatening postoperative complication after esophagectomy. The objective of this study was to find a safe and effective surgical method to reduce the incidence of AMPCL. METHODS: A total of 223 patients who underwent surgery in Fujian Medical University Union Hospital from May 2020 to October 2021 were enrolled in this study. Data for preoperative and postoperative test indices, postoperative complications, perioperative treatment were collected. After using 1:1 propensity score matching (PSM) to match two cohort (caliper = 0.1), the relationship between various factors and the incidence of AMPCL were analyzed. RESULTS: 209 patients were included for further analysis in the end. There were 95 patients in the sternocleidomastoid muscle flap embedding group (intervention group) and 114 in the routine operation group (control group). There was a significant difference in mean age between two groups. Gender, age, body mass index, diabetes, American society of anesthesiologists score, preoperative neoadjuvant therapy, pathological stage were included in performing 1:1 PSM, and there were no significant differences between two groups. Median operative time was significantly less in intervention group. Anastomotic leak (AL) did not present significant difference between two groups (8 [8.6] vs. 13 [14.0], p = 0.247), however, the AMPCL in intervention group was significantly lower than control group (0 [0] vs. 6 [6.5], p = 0.029). CONCLUSIONS: The sternocleidomastoid muscle flap embedding could significantly reduce the incidence of AMPCL. This additional procedure is safe, and effective without increase in the occurrence of postoperative complications and hospital expenses.
Authors: Olugbenga T Okusanya; Inderpal S Sarkaria; Nicholas R Hess; Katie S Nason; Manuel Villa Sanchez; Ryan M Levy; Arjun Pennathur; James D Luketich Journal: Ann Cardiothorac Surg Date: 2017-03
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