Lung Cancer Center, West China Hospital, Sichuan University, Chengdu.
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu.
Dis Esophagus. 2019 Jun 1;32(6). doi: 10.1093/dote/doz003.
Liver cirrhosis is sometimes encountered in esophageal cancer patients intended for surgery. However, the impact of liver cirrhosis on patients with surgically treated esophageal cancer remains unclear. Therefore, we conducted the first meta-analysis focusing on current topic. We comprehensively searched relevant studies in Pubmed, Embase, and Web of Science on September 3, 2018. Data for analysis included both short-term (including morbidity and mortality rates) and long-term (5-year survival rate) outcomes. Our meta-analysis was conducted by using the STATA 12.0 package. We finally included a total of six cohort studies involving a total of 1426 patients (161 cirrhotic patients and 1265 noncirrhotic patients). Meta-analysis showed that cirrhotic patients had a significantly higher morbidity rate (risk ratio (RR) = 1.226; 95% Confidence interval (CI) = [1.043, 1.442]; P = 0.014) than noncirrhotic patients. For specific complications, cirrhotic patients had a significantly higher rate of pulmonary complications (RR = 2.354; 95%CI = [1.376, 4.026]; P = 0.002) and pleural effusion (RR = 2.414; 95%CI = [1.482, 3.613]; P < 0.001) than noncirrhotic patients and there was a trend toward a higher rate of anastomotic leak (RR = 1.759; 95%CI = [0.945, 3.274]; P = 0.075) in cirrhotic patients. Moreover, cirrhotic patients also had a significantly higher mortality rate (RR = 2.529; 95%CI = [1.480, 4.324]; P = 0.001) than noncirrhotic patients. Cirrhotic patients tended to yield a lower 5-year survival rate than those noncirrhotic patients after surgical resection of esophageal cancer (RR = 0.715; 95%CI = [0.492, 1.039]; P = 0.079). In conclusion, liver cirrhosis was significantly correlated with high morbidity and mortality rates. However, there was no sufficient evidence of unfavorable survival in cirrhotic patients. Esophagectomy can be performed for certain esophageal cancer patients with concomitant liver cirrhosis with acceptable operative risks, providing that careful preoperative evaluation and patient selection have been achieved.
肝硬化在拟行手术的食管癌患者中偶有发生。然而，肝硬化对接受手术治疗的食管癌患者的影响尚不清楚。因此，我们进行了首次针对该主题的荟萃分析。我们于 2018 年 9 月 3 日在 Pubmed、Embase 和 Web of Science 中全面检索了相关研究。分析数据包括短期（包括发病率和死亡率）和长期（5 年生存率）结局。我们的荟萃分析使用了 STATA 12.0 软件包。最终我们共纳入了 6 项队列研究，共纳入了 1426 例患者（161 例肝硬化患者和 1265 例非肝硬化患者）。荟萃分析显示，肝硬化患者的发病率显著更高（风险比（RR）=1.226；95%置信区间（CI）=[1.043, 1.442]；P=0.014）。对于具体的并发症，肝硬化患者肺部并发症（RR=2.354；95%CI=[1.376, 4.026]；P=0.002）和胸腔积液（RR=2.414；95%CI=[1.482, 3.613]；P<0.001）的发生率显著更高，吻合口漏（RR=1.759；95%CI=[0.945, 3.274]；P=0.075）的发生率也呈上升趋势。此外，肝硬化患者的死亡率也显著更高（RR=2.529；95%CI=[1.480, 4.324]；P=0.001）。与非肝硬化患者相比，肝硬化患者在接受食管癌手术后的 5 年生存率也较低（RR=0.715；95%CI=[0.492, 1.039]；P=0.079）。总之，肝硬化与高发病率和死亡率显著相关。然而，目前没有足够的证据表明肝硬化患者的生存情况不佳。对于伴有肝硬化的某些食管癌患者，可进行手术切除，只要能够进行仔细的术前评估和患者选择，手术风险是可以接受的。
