Infectious complications occur frequently after esophagectomy. Selective decontamination of the digestive tract (SDD) has been shown to reduce postoperative infections and anastomotic leakage in gastrointestinal surgery, but robust evidence for esophageal surgery is lacking. The aim was to evaluate the association between SDD and pneumonia, surgical-site infections (SSIs), anastomotic leakage, and 1-year mortality after esophagectomy. A retrospective cohort study was conducted in patients undergoing Ivor Lewis esophagectomy in four Dutch hospitals between 2012 and 2018. Two hospitals used SDD perioperatively and two did not. SDD consisted of an oral paste and suspension (containing amphotericin B, colistin, and tobramycin). The primary outcomes were 30-day postoperative pneumonia and SSIs. Secondary outcomes were anastomotic leakage and 1-year mortality. Logistic regression analyses were performed to determine the association between SDD and the relevant outcomes (odds ratio (OR)). A total of 496 patients were included, of whom 179 received SDD perioperatively and the other 317 patients did not receive SDD. Patients who received SDD were less likely to develop postoperative pneumonia (20.1% vs. 36.9%, p < 0.001) and anastomotic leakage (10.6% vs. 19.9%, p = 0.008). Multivariate analysis showed that SDD is an independent protective factor for postoperative pneumonia (OR 0.40, 95% CI 0.23–0.67, p < 0.001) and anastomotic leakage (OR 0.46, 95% CI 0.26–0.84, p = 0.011). Use of perioperative SDD seems to be associated with a lower risk of pneumonia and anastomotic leakage after esophagectomy.

中文翻译：

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选择性消化道消化道清洁以预防食管切除术后的术后肺炎和吻合口漏：一项回顾性队列研究

食管切除术后常发生传染性并发​​症。消化道（SDD）的选择性净化已被证明可以减少胃肠道手术中的术后感染和吻合口漏，但缺乏食管手术的有力证据。目的是评估SDD与肺炎，手术部位感染（SSI），吻合口漏和食管切除术后1年死亡率之间的关系。在2012年至2018年之间，对荷兰的四家医院中接受Ivor Lewis食管切除术的患者进行了一项回顾性队列研究。两家医院在围手术期使用了SDD，而另外两家则没有。SDD由口服糊剂和混悬剂（含有两性霉素B，粘菌素和妥布霉素）组成。主要结果是术后30天的肺炎和SSI。次要结果是吻合口漏和1年死亡率。进行逻辑回归分析以确定SDD和相关结果之间的关联（比值比（OR））。总共包括496例患者，其中179例在手术期间接受了SDD，另外317例患者未接受SDD。接受SDD的患者术后发生肺炎的可能性较小（20.1％比36.9％，p <0.001）和吻合口漏（10.6％对19.9％，p = 0.008）。多因素分析表明，SDD是术后肺炎（OR 0.40，95％CI 0.23–0.67，p <0.001）和吻合口漏（OR 0.46，95％CI 0.26-0.84，p = 0.011）的独立保护因子。围手术期SDD的使用似乎与降低食管切除术后肺炎和吻合口漏的风险有关。