Backemar Lovisa, Lagergren Pernilla, Djärv Therese, Johar Asif, Wikman Anna, Lagergren Jesper
Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, NS 67, 2nd Floor, 17176, Stockholm, Sweden,
World J Surg. 2015 Sep;39(9):2282-8. doi: 10.1007/s00268-015-3093-6.
The selection for surgery is multifaceted for patients diagnosed with esophageal cancer. Since it is uncertain how comorbidity should influence the selection, this study addressed comorbidities in relation to risk of severe complications following esophageal cancer surgery.
This population-based cohort study was based on prospectively included patients who underwent surgical resection for an esophageal or gastro-esophageal junctional cancer in Sweden during 2001-2005. The participation rate was 90%. Associations between pre-defined comorbidities and pre-defined post-operative complications occurring within 30 days of surgery were analyzed using multivariable logistic regression. The resulting odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, sex, tumor stage, tumor histology, neoadjuvant therapy, type of surgery, annual hospital volume, other comorbidities, and other complications.
Among 609 included patients, those with cardiac disease (n = 92) experienced an increased risk of pre-defined complications in general (adjusted OR 1.81, 95% CI 1.13-2.90), while patients with hypertension (n = 137), pulmonary disorders (n = 79), diabetes (n = 67), and obesity (n = 66) did not. Patients with a Charlson comorbidity index score ≥2 had substantially increased risks of pre-defined complications (adjusted OR 2.44, 95% CI 1.60-3.72).
Cardiac disease and a Charlson comorbidity index score ≥2 seem to increase the risk of severe and early post-operative complications in patients with esophageal cancer, while hypertension, pulmonary disorders, diabetes, and obesity do not. These findings should be considered in the clinical decision-making for improved selection of patients for surgery.
对于被诊断为食管癌的患者，手术选择是多方面的。由于尚不确定合并症应如何影响手术选择，本研究探讨了与食管癌手术后严重并发症风险相关的合并症。
这项基于人群的队列研究基于2001年至2005年期间在瑞典接受食管或食管胃交界癌手术切除的前瞻性纳入患者。参与率为90%。使用多变量逻辑回归分析预先定义的合并症与手术30天内发生的预先定义的术后并发症之间的关联。所得比值比（OR）和95%置信区间（CI）针对年龄、性别、肿瘤分期、肿瘤组织学、新辅助治疗、手术类型、年医院手术量、其他合并症和其他并发症进行了调整。
在纳入的609例患者中，患有心脏病的患者（n = 92）总体上发生预先定义并发症的风险增加（调整后的OR为1.81，95% CI为1.13 - 2.90），而患有高血压的患者（n = 137）、肺部疾病的患者（n = 79）、糖尿病的患者（n = 67）和肥胖的患者（n = 66）则没有。Charlson合并症指数评分≥2的患者发生预先定义并发症的风险大幅增加（调整后的OR为2.44，95% CI为1.60 - 3.72）。
心脏病和Charlson合并症指数评分≥2似乎会增加食管癌患者术后严重和早期并发症的风险，而高血压、肺部疾病、糖尿病和肥胖则不会。在临床决策中应考虑这些发现，以改善手术患者的选择。
