Saeki Hiroshi, Tsutsumi Satoshi, Tajiri Hirotada, Yukaya Takafumi, Tsutsumi Ryosuke, Nishimura Sho, Nakaji Yu, Kudou Kensuke, Akiyama Shingo, Kasagi Yuta, Nakanishi Ryota, Nakashima Yuichiro, Sugiyama Masahiko, Ohgaki Kippei, Sonoda Hideto, Oki Eiji, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ann Surg. 2017 Mar;265(3):527-533. doi: 10.1097/SLA.0000000000001692.
The objective of this study was to elucidate the impact of postoperative complications on long-term survival after curative resection for esophageal squamous cell carcinoma.
The relation between postoperative complications and long-term survival after curative surgery for esophageal squamous cell carcinoma is controversial; thus, this issue should be resolved with a large-scale, well-designed study.
Clinicopathological features and survival of 580 consecutive patients who received curative resection for esophageal squamous cell carcinoma were investigated according to the development of postoperative pulmonary complications and anastomotic leakage.
The 5-year survival rates of patients with pStage 0, I, and II disease with postoperative complications (n = 116) were significantly poorer than those of patients without postoperative complications (n = 288) (overall 69.6% vs 46.9%, P < 0.0001; disease-specific; 76.7% vs 58.9%, P < 0.0022), whereas no differences were found in patients with pStage III and IV disease (n = 176). In the univariate and multivariate analyses for disease-specific survival, pT3, pT4, pN positivity, and development of postoperative complications were significant prognostic factors in all patients. Also, when the analysis was limited to the pStage 0, I, and II patients, development of postoperative complications, and pT3, pT4, and pN positivity, were found to be independent poor prognostic factors in multivariate analyses (hazard ratio: 1.56, 95% confidence interval, 1.01-2.41, P = 0.0476).
The development of postoperative complications is an independent disease-specific poor prognostic factor after curative resection for patients with less-advanced esophageal squamous cell carcinoma.
本研究旨在阐明术后并发症对食管鳞状细胞癌根治性切除术后长期生存的影响。
食管鳞状细胞癌根治性手术后，术后并发症与长期生存之间的关系存在争议；因此，这个问题应该通过大规模、精心设计的研究来解决。
根据术后肺部并发症和吻合口漏的发生情况，对580例连续接受食管鳞状细胞癌根治性切除的患者的临床病理特征和生存情况进行了调查。
术后出现并发症的pStage 0、I和II期疾病患者（n = 116）的5年生存率显著低于无术后并发症的患者（n = 288）（总体为69.6%对46.9%，P < 0.0001；疾病特异性为76.7%对58.9%，P < 0.0022），而pStage III和IV期疾病患者（n = 176）未发现差异。在疾病特异性生存的单因素和多因素分析中，pT3、pT4、pN阳性以及术后并发症的发生是所有患者的重要预后因素。此外，当分析仅限于pStage 0、I和II期患者时，术后并发症的发生以及pT3、pT4和pN阳性在多因素分析中被发现是独立的不良预后因素（风险比：1.56，95%置信区间，1.01 - 2.41，P = 0.0476）。
对于进展期较低的食管鳞状细胞癌患者，术后并发症的发生是根治性切除术后独立的疾病特异性不良预后因素。
