Stephens M R, Lewis W G, Brewster A E, Lord I, Blackshaw G R J C, Hodzovic I, Thomas G V, Roberts S A, Crosby T D L, Gent C, Allison M C, Shute K
Gwent Healthcare NHS Trust, Royal Gwent Hospital, Newport, UK.
Dis Esophagus. 2006;19(3):164-71. doi: 10.1111/j.1442-2050.2006.00559.x.
We aim to compare the outcomes of patients undergoing R0 esophagectomy by a multidisciplinary team (MDT) with outcomes after surgery alone performed by surgeons working independently in a UK cancer unit. An historical control group of 77 consecutive patients diagnosed with esophageal cancer and undergoing surgery with curative intent by six general surgeons between 1991 and 1997 (54 R0 esophagectomies) were compared with a group of 67 consecutive patients managed by the MDT between 1998 and 2003 (53 R0 esophagectomies, 26 patients received multimodal therapy). The proportion of patients undergoing open and closed laparotomy and thoracotomy decreased from 21% and 5%, respectively, in control patients, to 13% and 0% in MDT patients (chi2 = 11.90, DF = 1, P = 0.001; chi2 = 5.45, DF = 1, P = 0.02 respectively). MDT patients had lower operative mortality (5.7%vs. 26%; chi2 = 8.22, DF = 1, P = 0.004) than control patients, and were more likely to survive 5 years (52%vs. 10%, chi2 = 15.05, P = 0.0001). In a multivariate analysis, MDT management (HR = 0.337, 95% CI = 0.201-0.564, P < 0.001), lymph node metastases (HR = 1.728, 95% CI = 1.070-2.792, P = 0.025), and American Society of Anesthesiologists grade (HR = 2.207, 95% CI = 1.412-3.450, P = 0.001) were independently associated with duration of survival. Multidisciplinary team management and surgical subspecialization improved outcomes after surgery significantly for patients diagnosed with esophageal cancer.
我们旨在比较由多学科团队（MDT）进行R0食管癌切除术的患者的治疗结果与英国一家癌症治疗中心独立工作的外科医生单纯手术后的治疗结果。将1991年至1997年间由六位普通外科医生连续诊断为食管癌并接受根治性手术的77例患者（54例行R0食管癌切除术）作为历史对照组，与1998年至2003年间由MDT治疗的67例连续患者（53例行R0食管癌切除术，26例患者接受多模式治疗）进行比较。接受开腹和开胸手术的患者比例在对照组中分别为21%和5%，在MDT组中降至13%和0%（卡方检验，分别为χ2 = 11.90，自由度DF = 1，P = 0.001；χ2 = 5.45，自由度DF = 1，P = 0.02）。MDT组患者的手术死亡率低于对照组（5.7%对26%；χ2 = 8.22，自由度DF = 1，P = 0.004），并且更有可能存活5年（52%对10%，χ2 = 15.05，P = 0.0001）。在多变量分析中，MDT管理（风险比HR = 0.337，95%置信区间CI = 0.201 - 0.564，P < 0.001）、淋巴结转移（HR = 1.728，95%置信区间CI = 1.070 - 2.792，P = 0.025）和美国麻醉医师协会分级（HR = 2.207，95%置信区间CI = 1.412 - 3.450，P = 0.001）与生存时间独立相关。多学科团队管理和外科亚专业化显著改善了食管癌患者手术后的治疗结果。
