Lingohr Philipp, Zender Julia, van Beekum Cornelius, Dohmen Jonas, Matthaei Hanno, Schaefer Nico, Kalff Jörg C, Vilz Tim Oliver
Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland.
Zentralbl Chir. 2018 Apr;143(2):171-180. doi: 10.1055/s-0043-119892. Epub 2017 Dec 7.
Esophageal malignoma is among the most frequent causes for cancer-related deaths. The only definite curative therapy is esophagectomy embedded in various multimodal treatment regimens. The aim of this study was to evaluate long-term development after esophageal surgery in the last two decades in order to observe possible trends and their influence on short, medium and long term survival.
Cases of 301 patients who underwent esophagectomy between 1989 and 2012 were analysed retrospectively. To investigate possible changes in perioperative management and their influence on prognosis patients were divided into two cohorts (A: surgery between 1989 and 2000; B: surgery between 2001 and 2012) and further analyzed with regard to demographics, tumor entity, stage, complications and survival. Statistics were conducted to compare both groups while p ≤ 0.05 was regarded as statistically significant.
In cohort B patients were significantly older compared to cohort A and underwent surgery in earlier tumor stages with a higher lymphnode yield. Also an increased incidence of adenocarcinoma was observed. While overall morbidity did not change significantly, a decreased rate of anastomotic leakage was observed in cohort B (5.5%) compared to cohort A (12.3%) accompanied by a simultaneous increase in cardiac events (A: 3.6% vs. B: 12.3%). Overall 30-days-mortality was 2.7% and decreased significantly from 5% in cohort A to 0.7% in cohort B (p = 0.05). Median survival was 46 ± 7 month in cohort A, in cohort B an increase could be observed (53 ± 7 months, p = 0.03). By univariate analysis we could demonstrate that stage, affected lymph nodes, lymphnode ratio (LNR) and incidence of postoperative complications were significant predictors for the survival whereas in multivariate analysis T-stage, R-status and LNR were independent predictors for patients outcome.
Patients undergoing esophageal resection for cancer nowadays are older than in the past decades. Earlier cancer diagnosis, more radical surgical techniques with an extended lymphnode dissection, a decrease in anastomotic leakage and an improved perioperative care seem to compensate for this potential demographic disadvantage. The most important independent predictor of outcome after esophageal resection is the LNR.
食管恶性肿瘤是癌症相关死亡的常见原因之一。唯一明确的治愈性治疗方法是在各种多模式治疗方案中进行食管切除术。本研究的目的是评估过去二十年食管手术后的长期发展情况，以观察可能的趋势及其对短期、中期和长期生存的影响。
回顾性分析了1989年至2012年间接受食管切除术的301例患者的病例。为了研究围手术期管理的可能变化及其对预后的影响，将患者分为两个队列（A组：1989年至2000年手术；B组：2001年至2012年手术），并进一步分析其人口统计学、肿瘤类型、分期、并发症和生存情况。进行统计学分析以比较两组，p≤0.05被视为具有统计学意义。
与A组相比，B组患者年龄显著更大，手术时肿瘤分期更早，淋巴结清扫数量更多。同时腺癌发病率有所增加。虽然总体发病率没有显著变化，但B组吻合口漏发生率（5.5%）低于A组（12.3%），同时心脏事件发生率有所增加（A组：3.6% vs. B组：12.3%）。总体30天死亡率为2.7%，从A组的5%显著下降至B组的0.7%（p = 0.05）。A组中位生存期为46±7个月，B组有所增加（53±7个月，p = 0.03）。单因素分析表明，分期、受累淋巴结、淋巴结比率（LNR）和术后并发症发生率是生存的重要预测因素，而多因素分析显示T分期、R状态和LNR是患者预后的独立预测因素。
如今接受食管癌切除术的患者比过去几十年的患者年龄更大。更早的癌症诊断、更激进的手术技术及扩大的淋巴结清扫、吻合口漏的减少和围手术期护理的改善似乎弥补了这一潜在的人口统计学劣势。食管切除术后最重要的独立预后预测因素是LNR。
