Sato Shinsuke, Nagai Erina, Taki Yusuke, Watanabe Masaya, Watanabe Yuki, Nakano Kiyokaze, Yamada Hiroyuki, Chiba Takuya, Ishii Yuichiro, Ogiso Hiroshi, Takagi Masakazu
Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan.
Department of Rehabilitation, Shizuoka General Hospital, Shizuoka, Japan.
Esophagus. 2018 Jan;15(1):10-18. doi: 10.1007/s10388-017-0587-3. Epub 2017 Jul 13.
Radical esophagectomy remains the primary treatment option for resectable esophageal cancer. However, it sometimes induces postoperative complications due to its invasive nature. Recently, the impact of loss of muscle mass on postoperative complications and survival among cancer patients has been highlighted. This study aimed to identify the impact of low hand grip strength (HGS) on postoperative complications after esophagectomy.
A total of 188 patients (male: 166, female: 22) who underwent radical esophagectomy with gastric tube reconstruction between 2008 and 2014 were included. The correlation between HGS and age was analyzed using Pearson's correlation coefficient. Due to the small patient numbers, only male patients were stratified into two groups according to age (<70 years: non-elderly group, ≥70 years: elderly group). Receiver operating characteristic curve analysis was performed for each group using postoperative complication occurrence as the endpoint to determine an optimal HGS cutoff value.
Postoperative complications occurred in 60.9% of the elderly group and 47.4% of the non-elderly group. When the cutoff values were set at 30.5 and 37 kg for the elderly and non-elderly group, respectively, low HGS was an independent predictive factor of postoperative complications on multivariate analysis only in the elderly group (p = 0.008). In the elderly group, the incidence of postoperative pneumonia was 39.5% among patients with low HGS vs. 3.8% among patients with high HGS.
Preoperative HGS is an independent predictive factor of postoperative complications, especially postoperative pneumonia, for elderly male patients with esophageal cancer treated with radical esophagectomy.
根治性食管切除术仍然是可切除食管癌的主要治疗选择。然而，由于其侵入性，有时会引发术后并发症。最近，肌肉量减少对癌症患者术后并发症和生存的影响受到了关注。本研究旨在确定低握力（HGS）对食管切除术后并发症的影响。
纳入2008年至2014年间接受根治性食管切除术并采用胃管重建的188例患者（男性：166例，女性：22例）。使用Pearson相关系数分析HGS与年龄之间的相关性。由于患者数量较少，仅将男性患者按年龄分为两组（<70岁：非老年组，≥70岁：老年组）。以术后并发症发生情况为终点，对每组进行受试者操作特征曲线分析，以确定最佳HGS临界值。
老年组术后并发症发生率为60.9%，非老年组为47.4%。当老年组和非老年组的临界值分别设定为30.5和37 kg时，多因素分析显示仅在老年组中低HGS是术后并发症的独立预测因素（p = 0.008）。在老年组中，低HGS患者术后肺炎发生率为39.5%，而高HGS患者为3.8%。
对于接受根治性食管切除术治疗的老年男性食管癌患者，术前HGS是术后并发症尤其是术后肺炎的独立预测因素。
