Gockel Ines, Exner Christoph, Junginger Theodor
Department of General and Abdominal Surgery, Johannes Gutenberg University of Mainz, Germany.
World J Surg Oncol. 2005 Jun 21;3:37. doi: 10.1186/1477-7819-3-37.
The study was aimed to identify pre- and intraoperative risk factors that potentially influence morbidity and mortality after esophagectomy for esophageal carcinoma with particular emphasis on the predominant tumor types.
Between September 1985 and March 2004, 424 patients underwent esophagectomy for esophageal carcinoma. Of these, 186 (43.9%) patients had a transhiatal, and 231 (54.5%) patients underwent a transthoracic procedure with two-field lymphadenectomy. Pre-, intraoperative risk factors and tumor characteristics were included in the risk analysis to assess their influence on postoperative morbidity and mortality.
Multivariate analysis (logistic regression model) identified the surgical procedure as the most important risk factor for postoperative morbidity and mortality with the transthoracic technique associated with a significant higher risk. The comparison of the risk profile between the different histological tumor types, a significantly higher nutritional risk, poorer preoperative lung function and a higher prevalence of hepatopathy was observed in patients with squamous cell carcinoma (n = 229) compared to adenocarcinoma (n = 150) (p < 0.05). Although there was no significant difference in surgical complications between the two groups, the rate of general complications, length of postoperative intensive care unit-stay and mortality rate was significantly higher in patients with squamous cell carcinoma (p < 0.05).
The present risk analysis shows that the selection and the type of the surgical procedure are crucial factors for both the incidence of postoperative complications and the mortality rate. The higher risk of the transthoracic procedure is justified with a view to a better long term prognosis.
本研究旨在确定食管癌食管切除术后可能影响发病率和死亡率的术前及术中危险因素，尤其侧重于主要肿瘤类型。
1985年9月至2004年3月期间，424例患者接受了食管癌食管切除术。其中，186例（43.9%）患者采用经裂孔手术，231例（54.5%）患者接受了经胸手术并进行两野淋巴结清扫。风险分析纳入了术前、术中危险因素及肿瘤特征，以评估它们对术后发病率和死亡率的影响。
多因素分析（逻辑回归模型）确定手术方式是术后发病率和死亡率的最重要危险因素，经胸手术技术相关风险显著更高。与腺癌患者（n = 150）相比，鳞状细胞癌患者（n = 229）的不同组织学肿瘤类型之间的风险特征比较显示，营养风险显著更高、术前肺功能较差且肝病患病率更高（p < 0.05）。尽管两组手术并发症无显著差异，但鳞状细胞癌患者的总体并发症发生率、术后重症监护病房住院时间和死亡率显著更高（p < 0.05）。
目前的风险分析表明，手术方式的选择和类型是术后并发症发生率和死亡率的关键因素。考虑到更好的长期预后，经胸手术的较高风险是合理的。
