Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, European School of Physiotherapy, Faculty of Health, Amsterdam, Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam, Netherlands.
Eur J Surg Oncol. 2020 Jan;46(1):173-179. doi: 10.1016/j.ejso.2019.08.005. Epub 2019 Aug 6.
To optimally target physiotherapy treatment, knowledge of the pre- and postoperative course of functional status in patients undergoing esophagectomy is required. The aim of this prospective longitudinal study was to investigate the course of functional status in patients with esophageal cancer before and after esophagectomy.
Functional status outcome measures of patients with esophageal cancer who underwent surgery between March 2012 and June 2016 were prospectively measured at 3 months and at 1 day before surgery and at 1 week and at 3 months after surgery. Analysis of repeated measurements with the mixed model approach was used to study changes over time.
Hundred fifty-five patients were measured at 3 months and at 1 day before surgery, of which 109 (70.3%) at 1 week and 60 (38.7%) at 3 months after surgery. Mean (SD) age at surgery was 63.5 years (9.3), and 122 patients (78.7%) were male. The incidence of postoperative complications was 83 (53.5%). Three months postoperatively, functional status measures returned to baseline levels, except from handgrip strength (beta [95% CI] -6.2 [-11.3 to -1.1]; P = 0.02) and fatigue (4.7 [0.7to 8.7]; P = 0.02). No differences were observed in the course of functional status between patients with and without postoperative complications.
Functional status of patients undergoing esophagectomy returned to baseline values three months after surgery, despite the high incidence of postoperative complications. This requires rethinking the concept of prehabilitation, where clearly not all patients benefit from high functional status to prevent postoperative complications.
为了使物理治疗达到最佳效果，需要了解接受食管癌切除术的患者手术前后功能状态的变化过程。本前瞻性纵向研究旨在调查食管癌患者在接受食管癌切除术前和术后的功能状态变化。
本研究前瞻性地测量了 2012 年 3 月至 2016 年 6 月期间接受手术的食管癌患者的功能状态结局指标，测量时间分别为术前 3 个月和术前 1 天，术后 1 周和术后 3 个月。采用混合模型方法分析重复测量数据，以研究随时间的变化。
共测量了 155 例患者在术前 3 个月和术前 1 天的功能状态，其中 109 例（70.3%）在术后 1 周，60 例（38.7%）在术后 3 个月进行了测量。手术时的平均（SD）年龄为 63.5 岁（9.3），122 例（78.7%）为男性。术后并发症的发生率为 83 例（53.5%）。术后 3 个月，除握力（β[95%CI]–6.2[-11.3 至-1.1]；P=0.02）和疲劳（4.7[0.7 至 8.7]；P=0.02）外，功能状态测量值均恢复到基线水平。在有无术后并发症的患者中，功能状态的变化过程没有差异。
尽管术后并发症发生率较高，但接受食管癌切除术的患者在术后 3 个月时功能状态恢复到基线水平。这需要重新思考术前康复的概念，显然并非所有患者都能从提高功能状态中受益，以预防术后并发症。
