Orringer, McKeown and Ivor Lewis esophagectomy are the most commonly performed procedures for esophageal and gastro-esophageal junction cancer. Anastomotic leakage remains a major problem after all types of esophagectomy and it is currently unknown whether anastomotic leakage severity is different between the types of esophagectomy. The aim of this study was to investigate the relationship between surgical techniques and the severity of anastomotic leakage in patients after Orringer esophagectomy, McKeown esophagectomy or Ivor Lewis esophagectomy. Methods All esophageal and gastro-esophageal junction cancer patients with anastomotic leakage after Orringer, McKeown or Ivor Lewis esophagectomy between 2011 and 2019 were selected from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). The primary outcome parameter was a composite endpoint of reoperation, intensive care unit (ICU) readmission and 30-day/in-hospital mortality. Secondary outcome parameters included postoperative complications, re-intervention rate, ICU and hospital length of stay. Results Data from 1034 patients with anastomotic leakage after Orringer (n = 287), McKeown (n = 397) and Ivor Lewis esophagectomy (n = 346) were evaluated. The primary endpoint occurred in 36.3% of patients with anastomotic leakage after Orringer esophagectomy, in 55.4% of patients with anastomotic leakage after McKeown esophagectomy and in 61.2% of patients with anastomotic leakage after Ivor Lewis esophagectomy (p < 0.001). When adjusting for potential confounding variables, the sequelae of anastomotic leakage after Orringer and McKeown esophagectomy remained less severe compared to anastomotic leakage after Ivor Lewis esophagectomy (OR 0.28, 95% CI 0.20–0.41, p < 0.001 and OR 0.71, 95% CI 0.52–0.97, p = 0.031, respectively). Conclusion Consequences of anastomotic leakage are most severe after Ivor Lewis esophagectomy, moderately severe after McKeown esophagectomy and least severe after Orringer esophagectomy. This study demonstrated that not only the incidence, but also the severity of anastomotic leakage should be considered in current clinical practice and in studies that compare leakage rates between different surgical techniques of esophagectomy.

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130 不同类型食管切除术后吻合口漏的严重程度：一项全国性队列研究

Orringer、McKeown 和 Ivor Lewis 食管切除术是食管和胃食管结合部癌最常用的手术。在所有类型的食管切除术后，吻合口漏仍然是一个主要问题，目前尚不清楚不同类型的食管切除术之间的吻合口漏严重程度是否不同。本研究的目的是调查 Orringer 食管切除术、McKeown 食管切除术或 Ivor Lewis 食管切除术患者术后手术技术与吻合口漏严重程度之间的关系。方法从荷兰上消化道癌审计（DUCA）中选择2011-2019年Orringer、McKeown或Ivor Lewis食管切除术后出现吻合口漏的所有食管和胃食管结合部癌患者。主要结果参数是再手术、重症监护病房 (ICU) 再入院和 30 天/住院死亡率的复合终点。次要结果参数包括术后并发症、再干预率、ICU 和住院时间。结果 评估了 Orringer (n = 287)、McKeown (n = 397) 和 Ivor Lewis 食管切除术 (n = 346) 术后 1034 例吻合口漏患者的数据。主要终点发生在 36.3% 的 Orringer 食管切除术后吻合口漏患者、55.4% 的 McKeown 食管切除术后吻合口漏患者和 61.2% 的 Ivor Lewis 食管切除术后吻合口漏患者（p < 0.001）。在调整潜在的混杂变量时，与 Ivor Lewis 食管切除术后吻合口漏相比，Orringer 和 McKeown 食管切除术后吻合口漏的后遗症仍然没有那么严重（OR 0.28, 95% CI 0.20–0.41, p < 0.001 和 OR 0.71, 95% CI 0.52–0.97, p = 0.031 ， 分别）。结论 吻合口漏的后果在 Ivor Lewis 食管切除术后最严重，在 McKeown 食管切除术后中重度，在 Orringer 食管切除术后最轻。这项研究表明，在目前的临床实践和比较不同食管切除术手术技术之间的渗漏率的研究中，不仅应考虑吻合口渗漏的发生率，还应考虑其严重程度。结论 吻合口漏的后果在 Ivor Lewis 食管切除术后最严重，在 McKeown 食管切除术后中重度，在 Orringer 食管切除术后最轻。这项研究表明，在目前的临床实践和比较不同食管切除术手术技术之间的渗漏率的研究中，不仅应考虑吻合口渗漏的发生率，还应考虑其严重程度。结论 吻合口漏的后果在 Ivor Lewis 食管切除术后最严重，在 McKeown 食管切除术后中重度，在 Orringer 食管切除术后最轻。这项研究表明，在目前的临床实践和比较不同食管切除术手术技术之间的渗漏率的研究中，不仅应考虑吻合口渗漏的发生率，还应考虑其严重程度。