Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
Acta Oncol. 2020 Jul;59(7):859-865. doi: 10.1080/0284186X.2020.1750694. Epub 2020 Apr 23.
Over the past two decades, hybrid and total minimally invasive esophagectomy for esophageal cancer (EC) has increasingly been implemented with the aim to improve morbidity, functional result and ultimately the prognosis in these patients. However, more results are warranted and in this single-center study we report long-time outcome in a cohort of cancer patients treated with hybrid esophagectomy (HE). Hundred and nine patients with EC operated with HE from November 2007 to June 2013 were included. Clinical, pathological and survival data were retrieved from the patient administration system and the Norwegian Cause of Death Registry. Patients alive were asked to fill out the Ogilvie dysphagia score, EORTC QLQ-C30 and EORTC QLQ-OG25. Survival was analyzed by Kaplan-Meier's method and prognostic factors by uni- and multivariable Cox regression analyses. Median overall follow-up time was 55 months (range 2-135) after R0-2 resection ( = 109) and 76 months (5-135) for R0 resection ( = 100). Five-year overall survival rate was 49% and 53%, respectively. Anastomotic leakage rate and 90-days mortality were 5% and 2%, respectively. Six patients (6%) had later surgery for metastases to mediastinum, hepatoduodenal ligament, brain, lung, liver or bladder median 26 months (4-51) after HE. Forty-one out of 51 patients alive (80%) filled out questionnaires after median 65.5 months (63-123) follow-up. All patients could eat normal food without ( = 37) or with ( = 4) problems. Nearly, half of the patients reported problems with reflux, one-third experienced fatigue and anxiety while one out of four had weight loss and episodes of dyspnea. In this patient series, HE offered low postoperative mortality and good overall long-term survival. Most survivors maintained good quality of life more than five years post treatment. There was a low rate of serious postoperative complications.
在过去的二十年中，杂交和完全微创食管癌（EC）切除术越来越多地应用于这些患者，旨在改善发病率、功能结果，并最终改善预后。然而，还需要更多的结果，在这项单中心研究中，我们报告了一组接受杂交食管癌切除术（HE）治疗的癌症患者的长期结果。纳入了 2007 年 11 月至 2013 年 6 月期间接受 HE 治疗的 109 例 EC 患者。从患者管理系统和挪威死因登记处检索临床、病理和生存数据。对仍存活的患者进行问卷调查，内容包括 Ogilvie 吞咽困难评分、EORTC QLQ-C30 和 EORTC QLQ-OG25。通过 Kaplan-Meier 方法分析生存情况，通过单变量和多变量 Cox 回归分析预后因素。R0-2 切除术后的中位总随访时间为 55 个月（范围 2-135）（ = 109），R0 切除术后的中位随访时间为 76 个月（范围 5-135）（ = 100）。5 年总生存率分别为 49%和 53%。吻合口漏发生率和 90 天死亡率分别为 5%和 2%。6 例（6%）患者因纵隔、肝十二指肠韧带、脑、肺、肝或膀胱转移而接受后续手术，中位时间为 HE 后 26 个月（范围 4-51）。51 例存活患者中，41 例（80%）在中位随访 65.5 个月（范围 63-123）后填写了问卷。所有患者均能正常进食（ = 37）或进食时存在问题（ = 4）。近一半的患者报告有反流问题，三分之一的患者感到疲劳和焦虑，四分之一的患者体重减轻并出现呼吸困难。在该患者系列中，HE 术后死亡率低，总体长期生存率高。大多数幸存者在治疗后 5 年以上仍保持良好的生活质量。术后严重并发症发生率低。
