Harada K, Yoshida N, Baba Y, Nakamura K, Kosumi K, Ishimoto T, Iwatsuki M, Miyamoto Y, Sakamoto Y, Ajani J A, Watanabe M, Baba H
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto.
Department of Gastrointestinal Medical Oncology at the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Dis Esophagus. 2018 Mar 1;31(3). doi: 10.1093/dote/dox127.
Weight loss after esophagectomy is common and is associated with unfavorable prognosis. However, the clinical features and surgical methods that influence postesophagectomy weight loss are not well characterized. This study aims to determine those features (especially the surgical methods) that may affect postoperative weight loss. We reviewed 221 esophageal cancer patients who had undergone esophagectomy at Kumamoto University Hospital (Kumamoto, Japan) between November 2012 and June 2015. Among these, we recruited 106 patients who had undergone transthoracic esophagectomy with gastric conduit reconstruction, had no cancer recurrence within 1 year, and no missing follow-up data. We tabulated the body weight changes and risk factors associated with weight loss exceeding 10% at 1-year postesophagectomy. The mean body weights at baseline and 1-year postsurgery were 60.3 kg (standard error (SE): 0.91) and 52.6 (SE: 0.91), respectively. One year postsurgery, the body weights had changed as follows: mean: -12.2%; median: -12.9%; standard deviation: 9.06; range: -36.1-18.56%; interquartile range: -10.5 to -14.0%. In the multivariate logistic regression analysis, the absence of pyloroplasty was the sole risk factor for more than 10% weight loss (OR: 3.22; 95% CI: 1.08-11.9; P = 0.036). Our data suggest that pyloroplasty with esophagectomy can overcome the post-surgical weight loss.
食管癌切除术后体重减轻很常见，且与不良预后相关。然而，影响食管癌切除术后体重减轻的临床特征和手术方法尚未得到充分描述。本研究旨在确定那些可能影响术后体重减轻的特征（尤其是手术方法）。我们回顾了2012年11月至2015年6月间在日本熊本大学医院接受食管癌切除术的221例患者。其中，我们招募了106例接受经胸食管癌切除术并采用胃管道重建、术后1年内无癌症复发且无随访数据缺失的患者。我们将食管癌切除术后1年体重变化及与体重减轻超过10%相关的危险因素制成表格。基线时和术后1年的平均体重分别为60.3kg（标准误（SE）：0.91）和52.6kg（SE：0.91）。术后1年，体重变化如下：平均值：-12.2%；中位数：-12.9%；标准差：9.06；范围：-36.1 - 18.56%；四分位间距：-10.5至-14.0%。在多因素逻辑回归分析中，未进行幽门成形术是体重减轻超过10%的唯一危险因素（比值比：3.22；95%置信区间：1.08 - 11.9；P = 0.036）。我们的数据表明，食管癌切除术中进行幽门成形术可克服术后体重减轻。
