Mikrobiologische und klinische Wirksamkeit der selektiven Darmdekontamination bei der transthorakalen Resektion von Oesophagus- und Kardiacarcinomen

Background: Infectious complications are common after gastrointestinal surgery. Selective decontamination of the digestive tract (SDD) might reduce their incidence. SDD is used widely in colorectal resections, but its role in upper gastrointestinal resection is less clear. The aim of this study was to investigate the impact of SDD on postoperative outcome in upper gastrointestinal surgery. Methods: Studies investigating SDD in upper gastrointestinal surgery were included after search of medical databases (PubMed, Ovid, Cochrane Library and Google Scholar). Results were analysed according to predefined criteria. The incidence of perioperative overall complications and death was pooled. Risk of bias was assessed using the revised Cochrane risk-of-bias tool. Results: Some 1384 studies were identified, of which four RCTs were included in the final analysis. These studies included 415 patients, of whom 213 (51⋅3 per cent) received standard treatment/placebo and 202 (48⋅7 per cent) had SDD. The incidence of anastomotic leakage (odds ratio (OR) 0⋅39, 95 per cent c.i. 0⋅19 to 0⋅80; P = 0⋅010) and pneumonia (OR 0⋅42, 0⋅23 to 0⋅78; P = 0⋅006) was reduced in patients receiving SDD. Rates of surgical-site infection (P = 0⋅750) and mortality (P = 0⋅130) were not affected by SDD. Conclusion: SDD seems to be associated with reduction of anastomotic leakage and pneumonia following upper gastrointestinal resection, without affecting postoperative mortality. Funding information German Society of Surgery (FORTÜNE programme)

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Peri-Operative and Complication Management for Adenocarcinoma of the Oesophagus and Oesophagigastric Junction

Beckurts

2009

Adenocarcinoma of the Esophagogastric Junction

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Surgical resection of oesophageal cancer still offers the only chance of cure for this disease. Nevertheless, oesophageal surgery may be accompanied by relevant mortality and morbidity, the causes of which can be both directly related to surgical technique as well as a large spectrum of non-surgical complications. In the last few years, improvements in patient selection and technical advances, as well as elaborated peri- and post-operative management, have helped to reduce these threats.The following article addresses important aspects of patient selection and evaluation, pre-operative preparation, anaesthesia, operative prophylaxis of complications, immediate post-operative care and complication management. All these factors are important contributions to improve the outcome in this challenging medical condition. Nowadays, experienced centres report operative mortality rates of around 5% for radical transthoracic resections (Low et al. 2007; Or-ringer et al. 2007; Ando et al. 2000; Karl et al. 2000; Whooley et al. 2003), down from rates of up to 30 or 40% in previous decades (Earlam and Cunha-Melo 1980). Many factors have contributed to these improvements; some authors claim large volume centres have a tendency to improve results, mostly due to more aggressive management of post-operative complications (Forshaw et al. 2006; van Lanschot et al. 2001; Smith et al. 2008). The following article summarizes the factors that have been identified in the past decades to influence the outcome of major surgery for the resection of adenocarcinoma of the oesophagus.

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Mikrobiologische und klinische Wirksamkeit der selektiven Darmdekontamination bei der transthorakalen Resektion von Oesophagus- und Kardiacarcinomen

Cited by 9 publications

References 15 publications

Impact of Participant and Physician Intervention Preferences on Randomized Trials

Impact of Participant and Physician Intervention Preferences on Randomized Trials

Selective decontamination of the digestive tract in upper gastrointestinal surgery: systematic review with meta-analysis of randomized clinical trials

Peri-Operative and Complication Management for Adenocarcinoma of the Oesophagus and Oesophagigastric Junction

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