Francis David O, Hall Eric, Dang Jennifer H, Vlacich Gregory R, Netterville James L, Vaezi Michael F
Department of Otolaryngology, Nashville, Tennessee; Bill Wilkerson Center, Center for Surgical Quality & Outcomes Research, Nashville, Tennessee.
Laryngoscope. 2015 Apr;125(4):856-62. doi: 10.1002/lary.24987. Epub 2014 Oct 24.
OBJECTIVES/HYPOTHESIS: Dysphagia and esophageal stricture are frequent consequences of treatment for head and neck cancer. This study examines the effectiveness of the anterograde-retrograde rendezvous procedure and serial dilations in reestablishing esophageal patency to allow return to oral diet and gastrostomy tube removal in a cohort of patients with complete or near-complete esophageal stricture following nonsurgical cancer treatment.
Retrospective review of patients treated with radiation therapy with or without concurrent chemotherapy presented with complete or near-complete esophageal stricture. Patients underwent serial dilations using combined anterograde-retrograde dilation (rendezvous) techniques.
Medical records of patients having undergone treatment between 2006 and 2012 were reviewed, and semistructured interviews were also conducted to determine current swallowing function and actual patient experience. The primary outcome was swallowing improvement that allowed for return to oral diet and/or gastrostomy tube removal. Outcomes were compared between patients with complete and near-complete (<5 mm in diameter) strictures and univariate analysis performed to identify associations between patient, cancer, and treatment characteristics on odds of gastrostomy tube removal.
Twenty-four patients (median age 59.5 years, 63% male, 91% Caucasian) underwent treatment. Fifty percent of patients had complete occlusion of the esophageal lumen. The majority of patients (92%) underwent either anterograde (54%) or combined antero-retrograde (38%) approach. Following a median (interquartile range) of 9 (6-20) dilation sessions, 42% of patients were able to return to an oral diet and/or had their gastrostomy tube removed. This outcome was independent of whether the stricture was complete or near complete (P = .67). Of patients who had their gastrostomy tubes removed, only 33.3% had ever smoked, compared to 92.3% of those whose tubes were not discharged (P = .007).
Recannulation is possible even in cases of complete or near-complete stricture. Several factors appear to impact the likelihood of successful outcome, but in this study, only patients with a history of smoking had a significantly lower likelihood of return to full oral diet.
目的/假设：吞咽困难和食管狭窄是头颈癌治疗常见的后果。本研究探讨顺行-逆行会师术及系列扩张术在一组非手术癌症治疗后出现完全或近乎完全食管狭窄的患者中重建食管通畅，以使其恢复经口饮食并拔除胃造瘘管的有效性。
对接受放疗联合或不联合同步化疗且出现完全或近乎完全食管狭窄的患者进行回顾性研究。患者采用顺行-逆行联合扩张（会师）技术进行系列扩张。
回顾2006年至2012年间接受治疗的患者的病历，并进行半结构化访谈以确定当前的吞咽功能和患者的实际体验。主要结局是吞咽功能改善，从而能够恢复经口饮食和/或拔除胃造瘘管。比较完全性和近乎完全性（直径<5mm）狭窄患者的结局，并进行单因素分析以确定患者、癌症和治疗特征与拔除胃造瘘管几率之间的关联。
24例患者（中位年龄59.5岁，63%为男性，91%为白种人）接受了治疗。50%的患者食管腔完全闭塞。大多数患者（92%）采用顺行（54%）或顺行-逆行联合（38%）方法。经过中位（四分位间距）9（6-20）次扩张后，42%的患者能够恢复经口饮食和/或拔除胃造瘘管。这一结局与狭窄是完全性还是近乎完全性无关（P = 0.67）。在拔除胃造瘘管的患者中，只有33.3%曾经吸烟，而胃造瘘管未拔除的患者中这一比例为92.3%（P = 0.007）。
即使在完全或近乎完全狭窄的情况下，重新建立通道也是可能的。有几个因素似乎会影响成功结局的可能性，但在本研究中，只有有吸烟史的患者恢复完全经口饮食的可能性显著较低。
