Chowdappa Ramachandra, Tiwari Ajeet Ramamani, Arjunan Ravi, Althaf Syed, Kumar Rekha V, Chunduri Srinivas
Department of Surgical Oncology, Kidwai Cancer Institute, Bengaluru, India.
Department of Pathology, Kidwai Cancer Institute, Bengaluru, India.
Indian J Surg Oncol. 2019 Mar;10(1):83-90. doi: 10.1007/s13193-018-0825-8. Epub 2018 Nov 14.
Surgery for esophageal cancers carries high rates of morbidity and mortality despite improvements in perioperative care especially with increasingly safe anesthesia and postoperative ICU care. A case control study was conducted on 713 patients operated for esophageal cancer over a period of 8 years (2009-2016). Multiple preoperative, intraoperative, and postoperative clinical and laboratory parameters were compared between patients who succumbed to the surgery, i.e., 30-day mortality, and those who did not. Of the preoperative parameters, age > 58.5 years ( = 0.01), history of dysphagia with significant weight loss ( = 0.028), diabetes ( = 0.002), ischemic cardiac disease ( = 0.0001), low FEV1 < 69.5% ( = 0.036), preoperative length of hospital stay > 6.94 days ( = 0.001), involvement of gastroesophageal junction ( = 0.04), and ASA score > 2 ( = 0.002) were significantly associated with perioperative mortality. Intraoperatively, blood loss ( = 0.003), intraoperative ( = 0.015) and postoperative ( = 0.0001) blood transfusion, splenectomy ( = 0.0001), and excessive intraoperative intravenous fluids ( = 0.003) were associated with mortality. Decreased postoperative day 1 serum albumin level < 2.38 mg/dl ( = 0.0001), increased ICU stay > 7.32 days (SD+/- = 6.28, = 0.03), number of positive lymph nodes > 2.97 (SD+/- = 4.19, = 0.013), conduit necrosis ( = 0.0001), recurrent laryngeal nerve palsy ( = 0.013), pulmonary venous thromboembolism ( = 0.0001), multiple organ dysfunction syndrome ( = 0.0001), LRTI ( = 0.0001), arrhythmia ( = 0.005), sepsis ( = 0.0001), and ARDS ( = 0.0001) were the postoperative complications that were significantly associated with mortality. Comprehensive patient care involving preoperative optimization, improved surgical skills, rigorous intraoperative fluid management, and dedicated intensive care units will continue to play a major role in further minimizing mortality and morbidity associated with esophageal cancer surgeries.
尽管围手术期护理有所改善，尤其是麻醉安全性不断提高以及术后重症监护病房护理水平提升，但食管癌手术的发病率和死亡率仍然很高。对713例在8年期间（2009 - 2016年）接受食管癌手术的患者进行了一项病例对照研究。比较了死于手术的患者（即30天死亡率）和未死亡患者之间多个术前、术中和术后的临床及实验室参数。术前参数中，年龄>58.5岁（P = 0.01）、吞咽困难伴明显体重减轻病史（P = 0.028）、糖尿病（P = 0.002）、缺血性心脏病（P = 0.0001）、低FEV1<69.5%（P = 0.036）、术前住院时间>6.94天（P = 0.001）、胃食管交界处受累（P = 0.04）以及ASA评分>2（P = 0.002）与围手术期死亡率显著相关。术中，失血（P = 0.003）、术中（P = 0.015）和术后（P = 0.0001）输血、脾切除术（P = 0.0001）以及术中过量静脉输液（P = 0.003）与死亡率相关。术后第1天血清白蛋白水平降低<2.38mg/dl（P = 0.0001）、ICU住院时间延长>7.32天（标准差± = 6.28，P = 0.03）、阳性淋巴结数量>2.97（标准差± = 4.19，P = 0.013）、管道坏死（P = 0.0001）、喉返神经麻痹（P = 0.013）、肺静脉血栓栓塞（P = 0.0001）、多器官功能障碍综合征（P = 0.0001）、下呼吸道感染（P = 0.0001）、心律失常（P = 0.005）、败血症（P = 0.0001）和急性呼吸窘迫综合征（P = 0.0001）是与死亡率显著相关的术后并发症。涉及术前优化、提高手术技巧、严格术中液体管理以及专业重症监护病房的全面患者护理，将继续在进一步降低食管癌手术相关的死亡率和发病率方面发挥重要作用。
