Background/Objectives: Inadvertent intraoperative hypothermia is a common occurrence during major surgery, and some preclinical studies have reported its association with postoperative anastomotic leakage (AL). In the present study, we demonstrated the correlation between intraoperative hypothermia and postoperative outcomes after Ivor Lewis (IL) esophagectomy for cancer. Methods: Retrospectively, patients were divided into three groups on the basis of their time-weighted average temperatures (TWA): normothermia (N-TWA 36–37.5 °C), mild hypothermia (M-TWA 35–36 °C), and severe hypothermia (S-TWA < 35 °C). Results: Starting from 254 consecutive patients, 95 were included in the final analysis, classified according to intraoperative temperature: S-TWA = 19 (20%), M-TWA = 62 (65.3%), and N-TWA = 14 (14.7%). S-TWA was related to lower BMI (p= 0.001), diagnosis of squamous cell carcinoma (p= 0.029), and shorter operation times (p= 0.006). In the same way, AL was more related to S-TWA when compared with M-TWA and N-TWA (31.6% vs. 6.5% vs. 14.3%,p= 0.015). After multivariate analysis, S-TWA remained as the only predictive factor of AL (OR 5.385, 95%CI 1.502; 19.310;p= 0.010). Instead, higher BMI was found to be a protective factor for S-TWA (OR 0.818, 95%CI 0.723; 0.926:p= 0.001). Conclusions: S-TWA seems to be a major independent risk factor for AL after IL esophagectomy. Implementation of perioperative measures, aimed to prevent severe intraoperative hypothermia, could potentially be crucial to improve surgical outcomes.
背景/目的：重大手术中常发生非预期的术中低体温，部分临床前研究报道其与术后吻合口漏（AL）相关。本研究旨在探讨癌症患者接受Ivor Lewis（IL）食管切除术后，术中低体温与术后结局的相关性。方法：回顾性分析患者资料，根据时间加权平均体温（TWA）将患者分为三组：正常体温组（N-TWA 36–37.5 °C）、轻度低体温组（M-TWA 35–36 °C）和重度低体温组（S-TWA < 35 °C）。结果：从连续254例患者中筛选出95例纳入最终分析，按术中体温分组：S-TWA组19例（20%）、M-TWA组62例（65.3%）、N-TWA组14例（14.7%）。S-TWA与较低体重指数（BMI）（p=0.001）、鳞状细胞癌诊断（p=0.029）及较短手术时间（p=0.006）相关。同时，与M-TWA和N-TWA组相比，AL发生率在S-TWA组显著更高（31.6% vs. 6.5% vs. 14.3%，p=0.015）。多变量分析显示，S-TWA仍是AL的唯一预测因素（OR 5.385，95%CI 1.502-19.310，p=0.010），而较高BMI被发现是S-TWA的保护因素（OR 0.818，95%CI 0.723-0.926，p=0.001）。结论：S-TWA似乎是IL食管切除术后AL的主要独立危险因素。实施围手术期措施以预防重度术中低体温，可能对改善手术结局至关重要。
The Effect of Intraoperative Hypothermia on Anastomotic Leakage After Esophagectomy
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