Introduction: Transhiatal esophagectomy (THE) is used for specific gastroesophageal junction adenocarcinomas. THE is a high-risk surgical procedure. We aimed to assess the impact of postoperative sepsis (sepsis or septic shock) on the 1-year mortality after THE and to determine the risk factors associated with these outcomes. Secondly, we aimed to assess the impact of postoperative sepsis and other risk factors on 1-year cancer recurrence. Method: A retrospective, observational study was undertaken at the Paoli-Calmettes Institute, Marseille, from January 2012 to March 2022. Results: Of 118 patients, 24.6% (n = 29) presented with postoperative sepsis. Their 1-year mortality was 11% (n = 13), and their 1-year cancer recurrence was 23.7% (n = 28). In the multivariate analysis, independent factors for 1-year mortality were the following: postoperative sepsis (OR: 7.22 (1.11–47);p= 0.038), number of lymph nodes removed (OR: 0. 78 (0.64–0.95);p= 0.011), recurrence at one year (OR: 9.22 (1.66–51.1);p= 0.011), mediastinitis (OR: 17.7 (1.43–220);p= 0.025) and intraoperative driving pressure (OR: 1.77 (1.17–2.68);p= 0.015). For postoperative sepsis, independent factors were low-dose vasopressors (OR: 0.26; 95% CI: 0.07–0.95;p= 0.049), a cervical abscess (OR: 5.33; 95% CI: 1.5–18.9;p= 0.01), bacterial pneumonia (OR: 11.1; 95% CI: 2.99–41.0;p< 0.001) and a high SOFA score on day 1 (OR: 2.65; 95% CI: 1.36–5.19;p= 0.04). For 1-year cancer recurrence, independent factors were the number of lymph nodes removed (sHR: 0.87; 95% CI: 0.79–0.96;p= 0.005), pTNM stages of III or IV (sHR: 8.29; 95% CI: 2.71–25.32;p< 0.001) and postoperative sepsis (sHR: 6.54; 95% CI: 1.70–25.13;p= 0.005). Conclusions: Our study indicates that after THE, postoperative sepsis influences survival and cancer recurrence. We identified the associated risk factors, suggesting an early diagnosis might decrease mortality and recurrence.
引言：经膈肌裂孔食管切除术（THE）适用于特定的胃食管结合部腺癌。THE是一种高风险外科手术。本研究旨在评估术后脓毒症（脓毒症或脓毒性休克）对THE术后1年死亡率的影响，并确定与这些结局相关的风险因素。其次，我们旨在评估术后脓毒症及其他风险因素对1年癌症复发率的影响。 方法：在马赛Paoli-Calmettes研究所开展了一项回顾性观察研究，时间跨度为2012年1月至2022年3月。 结果：在118例患者中，24.6%（n=29）出现术后脓毒症。其1年死亡率为11%（n=13），1年癌症复发率为23.7%（n=28）。多变量分析显示，1年死亡率的独立影响因素包括：术后脓毒症（OR：7.22（1.11-47）；p=0.038）、淋巴结清扫数量（OR：0.78（0.64-0.95）；p=0.011）、一年内复发（OR：9.22（1.66-51.1）；p=0.011）、纵隔炎（OR：17.7（1.43-220）；p=0.025）以及术中驱动压（OR：1.77（1.17-2.68）；p=0.015）。对于术后脓毒症，其独立影响因素包括：低剂量血管加压药使用（OR：0.26；95% CI：0.07-0.95；p=0.049）、颈部脓肿（OR：5.33；95% CI：1.5-18.9；p=0.01）、细菌性肺炎（OR：11.1；95% CI：2.99-41.0；p<0.001）以及第1天高SOFA评分（OR：2.65；95% CI：1.36-5.19；p=0.04）。对于1年癌症复发，其独立影响因素包括：淋巴结清扫数量（sHR：0.87；95% CI：0.79-0.96；p=0.005）、pTNM III或IV期（sHR：8.29；95% CI：2.71-25.32；p<0.001）以及术后脓毒症（sHR：6.54；95% CI：1.70-25.13；p=0.005）。 结论：我们的研究表明，THE术后脓毒症影响患者生存和癌症复发。我们识别了相关风险因素，提示早期诊断可能有助于降低死亡率和复发率。
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