Pulmonary and cardiac complications following esophagectomy with reconstruction

[M. S. Đukanović]

80 str.

Medicina - Rekonstruktivna hirurgija / Medicine - Reconstructive surgery

Uvod: Plućne i srčane komplikacije nakon ezofagektomije su relativno česte i mogu se javiti u 10-40%. Cilj ovog istraţivanja je bio da ispita uticaj primene ERAS protokola sa akcentom na perioperativnu nadoknadu tečnosti na učestalost plućnih i srčanih komplikacija, kao i ukupnog morbiditeta nakon ezofagektomije. Metod: Ovo je retrospektivna opservaciona studija u kojoj su ispitivani bolesnici podvrgnuti ezofagektomiji sa rekonstrukcijom, podeljeni u dve grupe: bolesnici kod kojih je primenjen ERAS protokol i bolesnici kod kojih je primenjen standardan tretman. Ispitivana je učestalost nastanka plućnih i srčanih komplikacija, ukupnog velikog morbiditeta, 30- i 90-dnevni mortalitet. Rezultati: Od 121 bolesnika, 69 bolesnika je činilo ERAS grupu, dok je u kontrolnoj grupi bilo 52 bolesnika. Primenjen intraoperativni volumen tečnosti je bio manji u ERAS grupi 2000 (interquartile range- IQR, 1000-3750)ml u poreĎenju sa kontrolnom grupom, 3500 (IQR, 2000-5500) ml, p<0,001. Na prvom i drugom postoperativnom danu, kumulativni bilans tečnosti je bio manji u ERAS grupi u odnosu na kontrolnu (mediana 2215(IQR, -150-5880)ml vs. 4692,5 (IQR, 1770-10060) ml, p=0,002; 2250 (IQR, -1580 - 6030) ml vs. 4990 (IQR1400 - 9825) ml, p<0,001). Učestalost velikog morbiditeta je bila niţa u ERAS grupi u odnosu na kontrolnu (18,8% vs. 75%, p<0,001), ali bez statistički značajne razlike u 30-to dnevnom i 90-to dnevnom mortalitetu (p=0,07 i p=0,164, respektivno). U multivarijantnoj analizi nije postojala statistička značajnost u učestalosti postopertivne pneumonije i srčanih aritmija izmeĎu grupa. Verovantoća nastanka postoperativnog velikog morbiditeta i intersticijalnog plućnog edema je bila viša u kontrolnoj grupi (OR 5,637; 95%CI:1,178-10,98;p=0,030 i OR 5,955; 95%CI 1,702-9,084; p<0,001, respektivno). Zaključak: Primena ERAS protokola sa akcentom na perioperativni bilans tečnosti je dovela do smanjenja velikog morbiditeta bez uticaja na plućne i srčane komplikacije ponaosob.

Introduction: Pulmonary and cardiac complications following esophagectomy are common with incidence of 10-40%. The aim of this study was to examine impact of the ERAS protocol implemenation with accent on perioperative fluid management on frequency of pulmonary and cardiac complications, and major morbidity following esophagectomy. Method: This retrospective observational study investigated patients who underwent esophagectomy and divided them into two groups: ERAS group included patients with the ERAS protocol treatment and control group included patients with standard of care treatment. Frequency of pulmonary and cardiac complications, major morbidity, 30 and 90 days mortality were examined. Results: 121 patients were divided in two groups - the ERAS group had 69 patients, while 52 patients were included in the control group. Intraoperative total fluid volume was lower in the ERAS group 2000 (interquartile range, IQR, 1000-3750)ml in compared to the control group, median 3500 (IQR, 2000-5500)ml, p<0.001. On postoperative day 1 and 2, cumulative fluid balance was lower in the ERAS group in compared to the control group (median 2215 (IQR, -150-5880) ml vs. 4692.5 (IQR, 1770-10060) ml, p=0.002; 2250 (IQR, -1580 - 6030) ml vs. 4990 (IQR1400 - 9825) ml, p<0.001, respectively. Frequency of major morbidity was lower in the ERAS group in compared to the control (18.8% vs. 75%, p<0.001). There was no statistical significance in mortality at 30 and 90 days (p=0.07 i p=0.164, respectively). Multivariate analysis revealed that there was no statistically significant difference in the incidence of postoperative pneumonia and cardiac arrhythmia between groups. Possibility of developing major morbidity and interstitial pulmonary edema was greater in the control group (OR 5.637; 95%CI:1.178-10.98;p=0.030 i OR 5.955; 95%CI 1.702-9.084;p<0.001, respectively). Conclusion: The implementation of the ERAS protocol with accent on perioperative fluid balance reduces major morbidity without affecting pulmonary and cardiac complications itself.

perioperativna nadoknada tečnosti, veliki morbiditet, ERAS protokol, transtorakalna ezofagektomija, plućne komplikacije, srčane komplikacije

perioperative fluid balance, major morbidity, pulmonary complications, pneumonia, cardiac arrhythmia, cardiac complications, ERAS protocol, transthoracic esophagectomy

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