用胃管切除食道术治疗癌症后的教科书结果:2016-2021年国家外科质量改善计划分析
James J Park1, Giles F Whalen2, Isabel Cristina M Emmerick1
1Division of Thoracic Surgery, Department of Surgery, UMass Memorial Medical Center, UMass Chan Medical School, Worcester, Massachusetts.
The Journal of surgical research
|February 7, 2026
概括
教科书结局 (TO) 在68%的食道切除术患者中实现. 主要并发症和积极的外科手术边缘是预防TO的关键因素,突出了改善外科手术质量的领域.
科学领域:
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
- 提高质量 提高质量
背景情况:
- 教科书结果 (TO) 是评估短期外科结果的综合指标.
- 通过使用NSQIP数据库来定义食道切除术的TO对于质量评估至关重要.
研究的目的:
- 通过使用NSQIP数据库来定义食道切除术的教科书结果 (TO).
- 为了确定与未能在这个患者群体中实现TO相关的因素.
主要方法:
- 分析NSQIP食道切除术程序目标数据库 (2016-2021年).
- 包括接受选择性食道切除术的患者,因为可以切除的食道癌症.
- 基于无道泄漏,重大并发症,阳性边缘,重新干预,长期停留,死亡率和在特定时间范围内再接收的TO的定义.
主要成果:
- 在符合条件的患者中,68% (2520/3733) 实现了TO.
- 主要并发症 (19%) 和积极的外科手术边缘 (4.7%) 是未能实现TO的最常见原因.
- 多变量分析确定TNM节点阶段,COPD,ASA类4,体重不足BMI,亚洲种族,延长的操作时间,升高的WBC和年龄较大与TO失败有显著关联.
结论:
- 68%的食道切除术病例符合教科书中定义的结局标准.
- 几种患者和手术因素与未能达到TO的失败有关.
- 对可修改因素的进一步研究,例如手术前体重,可能会改善结果.
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