Moore Jessica M, Hooker Craig M, Molena Daniela, Mungo Benedetto, Brock Malcolm V, Battafarano Richard J, Yang Stephen C
Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Ann Thorac Surg. 2016 Jul;102(1):215-22. doi: 10.1016/j.athoracsur.2016.02.039. Epub 2016 May 21.
Complex esophageal reconstruction (CER) is defined as restoring esophageal continuity in a previously operated field, using a nongastric conduit, or after esophageal diversion. This study compares the outcomes of CER with non-CER (NCER), which uses an undisturbed stomach for reconstruction.
This single-institution retrospective cohort study compares 75 CERs with 75 NCERs from 1995 to 2014 that were matched for cancer versus benign disease. Distributions of demographic characteristics, comorbidities, and complications were compared between CER and NCER. Odds of mortality at 30 and 90 days were calculated with logistic regression. Overall survival was illustrated with Kaplan-Meier method and Cox proportional hazards regression.
Although patients were similar in age, sex, and preoperative comorbidities, more non-white patients underwent CER (p = 0.04). Most NCER patients had adenocarcinoma (44%) or Barrett's high-grade dysplasia (39%); most CER patients had other benign disease (44%) or squamous cell carcinoma (24%, p < 0.01). CER had statistically significantly higher rates of reoperation, pneumonia, infection, and gastrointestinal complications, and longer median length of stay than NCER. Odds of mortality for CER and NCER at 30 days (odds ratio [OR] 1.0, 95% CI: 0.1 to 16.3), 90 days (OR 2.6, 95% CI: 0.5 to 13.9) and overall (adjusted hazard ratio 1.56, 95% CI: 0.9 to 2.7) were not statistically significantly different.
Compared with NCER, CER patients had higher rates of return to the operating room, more postoperative infections and gastrointestinal complications, and longer length of stay. However, 30-day, 90-day, and overall survival were similar. CER should be offered to patients with acceptable risks and anticipated long-term survival.
复杂食管重建（CER）的定义为在先前手术区域恢复食管连续性，使用非胃管道，或在食管转流术后进行。本研究比较了CER与非CER（NCER）的结局，后者使用未受干扰的胃进行重建。
这项单机构回顾性队列研究比较了1995年至2014年期间75例CER患者和75例NCER患者，这些患者在癌症与良性疾病方面进行了匹配。比较了CER组和NCER组的人口统计学特征、合并症和并发症的分布情况。采用逻辑回归计算30天和90天的死亡几率。采用Kaplan-Meier法和Cox比例风险回归分析总生存率。
尽管患者在年龄、性别和术前合并症方面相似，但接受CER的非白人患者更多（p = 0.04）。大多数NCER患者患有腺癌（44%）或巴雷特高级别异型增生（39%）；大多数CER患者患有其他良性疾病（44%）或鳞状细胞癌（24%，p < 0.01）。与NCER相比，CER的再次手术率、肺炎、感染和胃肠道并发症发生率在统计学上显著更高，中位住院时间更长。CER和NCER在30天（比值比[OR] 1.0，95%可信区间：0.1至16.3）、90天（OR 2.6，95%可信区间：0.5至13.9）和总体（调整后风险比1.56，95%可信区间：0.9至2.7）的死亡几率在统计学上无显著差异。
与NCER相比，CER患者返回手术室的比例更高，术后感染和胃肠道并发症更多，住院时间更长。然而，30天、90天和总体生存率相似。对于具有可接受风险和预期长期生存的患者，应提供CER治疗。
