Purpose

The data on surgical outcomes of esophagectomy in patients with achalasia is limited. We sought to evaluate surgical outcomes in achalasia patients after an esophagectomy versus non-achalasia patients to elucidate if the outcomes are affected by the diagnosis.

Methods

We conducted a retrospective review of the National Surgical Quality Improvement Program database (2010–2018). Patients who underwent an esophagectomy (open or laparoscopic approach) were included. Patients were divided into two groups, achalasia vs non-achalasia patients, and matched using propensity match analysis.

Results

Of the 10,997 esophagectomy patients who met inclusion criteria, 213 (1.9%) patients had a diagnosis of achalasia. A total of 418 patients were included for the final analysis, with 209 patients in each group (achalasia vs non-achalasia). The overall median age was 57 years (IQR 47–65 years), and 48.6% were female. Most underwent an open (93.1%) vs laparoscopic (6.9%) esophagectomy. Overall complication rate was 40%. No difference was identified on overall complications, readmission, reoperation, or mortality between both groups. Postoperative sepsis was significantly higher in the achalasia group, and organ space SSI was higher in the non-achalasia group. Multivariable analysis showed that a diagnosis (achalasia or non-achalasia) was not predictive of reoperation or overall complications.

Conclusion

Esophagectomy outcomes are similar in patients with achalasia vs non-achalasia, and the diagnosis of achalasia does not independently increase the risk of reoperation and overall complications. Finally, regardless of diagnosis, the potential for morbidity following esophagectomy, should to be discussed with patients in the preoperative setting.

中文翻译：

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贲门失弛缓症患者食管切除术后的手术结果：与非贲门失弛缓症食管切除术患者的 NSQIP 匹配分析

 目的

关于贲门失弛缓症患者食管切除术手术结果的数据有限。我们试图评估食管切除术后贲门失弛缓症患者与非贲门失弛缓症患者的手术结果，以阐明结果是否受到诊断的影响。

 方法

我们对国家手术质量改进计划数据库（2010-2018）进行了回顾性审查。接受食管切除术（开放或腹腔镜手术）的患者也被纳入其中。将患者分为两组：贲门失弛缓症患者与非贲门失弛缓症患者，并使用倾向匹配分析进行匹配。

 结果

在 10,997 名符合纳入标准的食管切除患者中，213 名（1.9%）患者被诊断为贲门失弛缓症。最终分析共纳入 418 例患者，每组 209 例患者（贲门失弛缓症与非失弛缓症）。总体中位年龄为 57 岁（IQR 47-65 岁），其中 48.6% 为女性。大多数人接受了开腹食管切除术（93.1%）和腹腔镜食管切除术（6.9%）。总体并发症发生率为40%。两组之间的总体并发症、再入院、再次手术或死亡率没有差异。贲门失弛缓症组术后脓毒症显着较高，非贲门失弛缓症组器官间隙 SSI 较高。多变量分析表明，诊断（贲门失弛缓症或非贲门失弛缓症）并不能预测再次手术或总体并发症。

 结论

贲门失弛缓症患者与非贲门失弛缓症患者的食管切除术结果相似，并且贲门失弛缓症的诊断并不独立增加再次手术和总体并发症的风险。最后，无论诊断如何，应在术前与患者讨论食管切除术后潜在的发病率。