Second Department of General Surgery, Emergency Mureş County Hospital, University of Medicine and Pharmacy, Târgu Mureş, Romania.
Department of Epidemiology, University of Medicine and Pharmacy, Târgu Mureş, Romania.
Balkan Med J. 2015 Jan;32(1):38-45. doi: 10.5152/balkanmedj.2015.15514. Epub 2015 Jan 1.
The present study proposes to analyze the results obtained after transhiatal esophagectomies (THE), from the perspective of an Eastern European surgical center with low esophageal resection volume (LV).
Our analysis, which to the authors' knowledge is the first of its kind in Romania, has the purpose of comparing our results with those obtained in higher or similar volume centers, in order to derive conclusions regarding the quality of therapeutic management for patients diagnosed with esophageal cancer in Romania.
Retrospective observational study.
In total, 70 patients were included, in whom THE was performed during the period 1997-2013 by six senior surgeons. The majority of our patients had esophageal cancers (n=66; 94.3%); we also performed 4 THE procedures for benign conditions (n=3; 4.27%) and esophageal perforation (n=1; 1.42%).
The majority of cancer-group patients had T3/N+ tumors. The nodal involvement in the T2, T3 and T4 categories was 9.9%, 21.6% and 35.1%, respectively. Complications were identified in 45 patients (68.2%), with the majority being represented by pulmonary complications (16 patients; 24.3%) and cervical leaks (15 cases; 22.7%). In-hospital mortality was 9.09%. We found a one-year overall survival rate of 58.7% (95%CI: 51.7-65.7%), 27.2% at 2 years (95%CI: 21.2-36.2%) and 10.5% at 3 years (95%CI: 6.5-14.5%). The median survival rate was estimated to be 16 months.
Morbidity and in-hospital mortality after THE was performed in low-volume centers, despite being significantly higher than reported in HV centers, could be kept at reasonable rates. In our opinion, the measures which have the potential to raise the standard of care for patients diagnosed with esophageal cancer in Romania are represented by the standardization of therapeutic and diagnostic protocols for esophageal cancer and the centralization of these major oncologic interventions in surgical excellence centers.
本研究拟从东欧低食管切除术量（LV）的外科中心的角度分析经食管裂孔食管切除术（THE）的结果。
据作者所知，这是罗马尼亚首例此类分析，旨在将我们的结果与高容量或相似容量中心的结果进行比较，以得出关于罗马尼亚食管癌患者治疗管理质量的结论。
回顾性观察性研究。
共有 70 名患者纳入研究，其中 6 名资深外科医生在 1997 年至 2013 年期间对其进行了 THE 手术。我们的大多数患者患有食管癌（n=66；94.3%）；我们还对 4 例良性疾病（n=3；4.27%）和食管穿孔（n=1；1.42%）进行了 THE 手术。
癌症组患者多数为 T3/N+肿瘤。T2、T3 和 T4 期的淋巴结受累分别为 9.9%、21.6%和 35.1%。45 例患者（68.2%）出现并发症，其中以肺部并发症（16 例；24.3%）和颈漏（15 例；22.7%）为主。院内死亡率为 9.09%。我们发现 1 年总生存率为 58.7%（95%CI：51.7-65.7%），2 年生存率为 27.2%（95%CI：21.2-36.2%），3 年生存率为 10.5%（95%CI：6.5-14.5%）。中位生存时间估计为 16 个月。
尽管低容量中心行 THE 后的发病率和院内死亡率明显高于高容量中心，但仍可保持在合理水平。我们认为，提高罗马尼亚食管癌患者治疗水平的措施是规范食管癌治疗和诊断方案，并将这些主要的肿瘤干预措施集中在外科卓越中心。
