Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan,
Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan.
Oncology. 2020;98(5):280-288. doi: 10.1159/000505925. Epub 2020 Mar 10.
Recent studies have reported that the occurrence of postoperative complications after esophagectomy for esophageal cancer has a negative impact on long-term survival. Although salvage esophagectomy is associated with higher rates of morbidity and mortality, the impact of postoperative complications on long-term survival following salvage esophagectomy has not been fully investigated.
We retrospectively analyzed 73 patients with thoracic esophageal cancer who underwent salvage esophagectomy between January 1997 and December 2017 after definitive chemoradiotherapy. We investigated the clinical impact of postoperative complications on long-term survival after salvage esophagectomy.
Postoperative complications, pulmonary complications, and anastomotic leakage occurred in 34 (47%), 14 (13%), and 14 (19%) of the patients, respectively. Patients with complications had significantly poorer survival than patients who did not have complications (HR [hazard ratio], 2.06; p = 0.017), but there were no significant differences in overall survival between patients with and those without pulmonary complications or anastomotic leakage (HR, 1.48, p = 0.318, and HR, 1.37, p = 0.377, respectively). Multivariate analysis revealed that pathological T3-4 disease (HR, 4.63; p = 0.001), residual disease (HR, 5.09; p = 0.001), and postoperative complications (HR, 3.85; p = 0.001) were significant independent prognostic factors. In particular, the frequency of death from other diseases among patients with postoperative complications was nonsignificantly higher than among patients without postoperative complications (26 vs. 10%; p = 0.071).
The occurrence of complications leads to a poor prognosis for patients with esophageal cancer after salvage esophagectomy. Prevention of postoperative complications and long-term postoperative general supportive care might be important for improving patients' prognosis.
最近的研究报告称，食管癌手术后并发症的发生对长期生存有负面影响。虽然挽救性食管切除术与更高的发病率和死亡率相关，但手术后并发症对挽救性食管切除术后长期生存的影响尚未得到充分研究。
我们回顾性分析了 1997 年 1 月至 2017 年 12 月期间接受确定性放化疗后进行挽救性食管切除术的 73 例胸段食管癌患者。我们研究了手术后并发症对挽救性食管切除术后长期生存的临床影响。
术后并发症、肺部并发症和吻合口漏分别发生在 34 例（47%）、14 例（13%）和 14 例（19%）的患者中。有并发症的患者的生存明显差于无并发症的患者（HR[风险比]，2.06；p=0.017），但有肺部并发症和吻合口漏的患者的总生存率无显著差异（HR，1.48，p=0.318 和 HR，1.37，p=0.377）。多变量分析显示，病理 T3-4 疾病（HR，4.63；p=0.001）、残留疾病（HR，5.09；p=0.001）和术后并发症（HR，3.85；p=0.001）是显著的独立预后因素。特别是，有术后并发症的患者死于其他疾病的频率明显高于无术后并发症的患者（26%比 10%；p=0.071）。
食管癌患者挽救性食管切除术后并发症的发生导致预后不良。预防术后并发症和长期术后一般支持性护理可能对改善患者预后很重要。
