2021年 · 第101卷第30期

Primary liver cancer ranks sixth worldwide in cancer incidence and third in cancer-related deaths. Intrahepatic cholangiocarcinoma (iCCA) and hepatocellular carcinoma (HCC) are the most common primary liver cancers, of which HCC accounts for 80% and iCCA is 10% ~15%. Current evidence suggests that patients with iCCA may have a worse prognosis than those with HCC. Although extensive studies have been conducted on the epidemiology and pathophysiology of these two common liver cancers, differences in demography, clinical characteristics and prognosis between iCCA and HCC patients have not been compared in large-scale population survey studies.

Non-steroidal anti-inflammatory drugs (NSAIDs) are currently important analgesics in the implementation of accelerated rehabilitation surgery (ERAS). Recent evidence suggests that there is an association between postoperative ketorolac use and anastomotic leakage in patients undergoing colorectal surgery, but this association is still under-studied in esophageal cancer resection surgery. With increasing emphasis on non-opioid analgesic regimens and ERAS concepts, it is clinically important to determine the possible association between perioperative ketorolac use and anastomotic leakage. The study retrospectively collected clinical data of patients who underwent esophageal adenocarcinoma resection at the same institution from 2006 to 2018, summarized the occurrence of anastomotic leakage, and queried the institution's pharmacy records to understand the use of ketorolac during the hospitalization of surgical cases; Multivariate logistic regression was used to analyze the relationship between ketorolac application and anastomotic leakage. In the end, a total of 1 019 patients met the inclusion criteria, including 907 (89%) males with a mean age of 62 years. Patients presented mainly with locally advanced lesions and received initial chemoradiotherapy, a total of 686 patients (67%) were treated with ketorolac. During the study period, ketorolac use increased from 49% in 2006 to 92% in 2016. A total of 87 patients (9%) experienced anastomotic leakage, and the incidence of anastomotic leakage decreased over time from 15% (11/72) in 2006 to 2% (2/83) in 2018. The results of multivariate analysis showed that ketorolac administration regardless of whether as a categorical variable (OR=0.99，P=0.958), or use a continuous variable of dose (OR=1.00，P=0.843) were not shown to be associated with the occurrence of anastomotic leakage. This study suggests that the use of ketorolac after esophageal cancer resection has become an important part of the ERAS protocol and does not appear to be associated with anastomotic leakage.