First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
Dis Esophagus. 2021 Feb 10;34(2). doi: 10.1093/dote/doaa067.
The aim of this study is to describe outcomes of esophageal cancer surgery in a quaternary upper gastrointestinal (GI) center in Athens during the era of the Greek financial crisis. We performed a retrospective analysis of patients that underwent esophagectomy for esophageal or gastroesophageal junction (GEJ) cancer at an upper GI unit of the University of Athens, during the period January 2004-June 2019. Time-to-event analyses were performed to explore trends in survival and recurrence. A total of 146 patients were identified. Nearly half of the patients (49.3%) underwent surgery during the last 4 years of the financial crisis (2015-2018). Mean age at the time of surgery was 62.3 ± 10.3 years, and patients did not present at older ages during the recession (P = 0.50). Most patients were stage III at the time of surgery both prior to the recession (35%) and during the financial crisis (39.8%, P = 0.17). Ivor-Lewis was the most commonly performed procedure (67.1%) across all eras (P = 0.06). Gastric conduit was the most common form of GI reconstruction (95.9%) following all types of surgery (P < 0.001). Pre-recession anastomoses were usually performed using a circular stapler (65%). Both during (88.1%) and following the recession (100%), the vast majority of anastomoses were hand-sewn. R0 resection was achieved in 142 (97.9%) patients. Anastomosis technique did not affect postoperative leak (P = 0.3) or morbidity rates (P = 0.1). Morbidity rates were not significantly different prior to (25%), during (46.9%), and after (62.5%) the financial crisis, P = 0.16. Utilization of neoadjuvant chemotherapy (26.9%, P = 0.90) or radiation (8.4%, P = 0.44) as well as adjuvant chemotherapy (54.8%, P = 0.85) and irradiation (13.7%, P = 0.49) was the same across all eras. Disease-free survival (DFS) and all-cause mortality rates were 41.2 and 47.3%, respectively. Median DFS and observed survival (OS) were 11.3 and 22.7 months, respectively. The financial crisis did not influence relapse (P = 0.17) and survival rates (P = 0.91). The establishment of capital controls also had no impact on recurrence (P = 0.18) and survival (P = 0.94). Austerity measures during the Greek financial crisis did not influence long-term esophageal cancer outcomes. Therefore, achieving international standards in esophagectomy may be possible in resource-limited countries when centralizing care.
本研究旨在描述在希腊金融危机期间雅典一家四级上消化道（GI）中心进行的食管癌手术结果。我们对上消化道单位接受食管癌或胃食管交界处（GEJ）癌切除术的患者进行了回顾性分析，该单位位于雅典大学，研究时间为 2004 年 1 月至 2019 年 6 月。采用时间事件分析探讨生存和复发趋势。共确定了 146 名患者。将近一半的患者（49.3%）在金融危机的最后 4 年（2015-2018 年）接受了手术。手术时的平均年龄为 62.3±10.3 岁，在经济衰退期间患者年龄没有增加（P=0.50）。在经济衰退之前（35%）和金融危机期间（39.8%），大多数患者在手术时均处于 III 期（P=0.17）。在所有时期，Ivor-Lewis 是最常进行的手术（67.1%）（P=0.06）。胃管是所有类型手术后最常用的胃肠道重建方式（95.9%）（P<0.001）。在经济衰退之前（65%）和之后（88.1%），吻合通常使用圆形吻合器进行。在经济衰退之前（100%）和之后（100%），绝大多数吻合均采用手工缝合。142 名患者（97.9%）达到了 R0 切除。吻合技术不影响术后漏（P=0.3）或发病率（P=0.1）。在经济危机之前（25%）、期间（46.9%）和之后（62.5%），发病率无显著差异，P=0.16。新辅助化疗（26.9%，P=0.90）或放疗（8.4%，P=0.44）以及辅助化疗（54.8%，P=0.85）和放疗（13.7%，P=0.49）在所有时期的使用率相同。无病生存率（DFS）和全因死亡率分别为 41.2%和 47.3%。DFS 中位数和观察生存率（OS）分别为 11.3 和 22.7 个月。金融危机并未影响复发（P=0.17）和生存率（P=0.91）。资本管制的建立也对复发（P=0.18）和生存（P=0.94）没有影响。希腊金融危机期间的紧缩措施并未影响长期食管癌的结果。因此，在资源有限的国家集中医疗资源时，实现食管癌切除术的国际标准是可能的。
