Park Seong Yong, Jung Inkyung, Heo Seok Jae, Byun Go Eun, Lee Eun Young, Kim Dae Joon
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea.
J Gastrointest Surg. 2021 Mar;25(3):635-640. doi: 10.1007/s11605-020-04766-5. Epub 2020 Aug 10.
After esophagectomy, various reconstruction routes can be considered for technical and oncologic objectives. The substernal route is believed to cause more dysphagia or delayed gastric emptying symptoms than the posterior mediastinal route. We evaluated and compared the quality of life (QoL) after reconstruction by either the substernal or posterior mediastinal routes in the McKeown procedure.
Between 2011 and 2018, 378 patients who received an esophagectomy and cervical esophagogastrostomy for esophageal cancer were followed up. Among these patients, 278 received reconstruction via the substernal route and 100 via the posterior mediastinal route. Patients completed the validated questionnaires, EORTC QLQ-C30 and QLQ-OES18, before surgery and at 1, 2, 3, 6, 12, and 24 months after surgery. Linear mixed-effects models were used to examine changes in questionnaire scores over time.
One month after surgery, patients QoL deteriorated and more symptoms were observed than at baseline. Global health status, nausea and vomiting, and esophageal pain gradually recovered from 2 months and recovered to initial levels at 2 years. However, the other functional and symptom scales of the QLQ-C30 and OES18 were not normalized at 2 years after the operation. When comparing the substernal and posterior mediastinal routes, QLQ-OES18 symptom scales, such as eating, dysphagia, trouble with swallowing saliva trouble with taste and reflux, were no different between the two groups, even after adjusting confounding factors at 2 years after the operation.
The cervical esophagogastrostomy with a substernal route showed comparable QoL to reconstruction with a posterior mediastinal route.
食管癌切除术后，出于技术和肿瘤学目的可考虑多种重建路径。与后纵隔路径相比，胸骨后路径被认为会导致更多吞咽困难或胃排空延迟症状。我们评估并比较了在麦克尤恩手术中采用胸骨后或后纵隔路径重建后的生活质量（QoL）。
在2011年至2018年期间，对378例行食管癌切除及颈部食管胃吻合术的患者进行随访。其中，278例采用胸骨后路径重建，100例采用后纵隔路径重建。患者在手术前以及术后1、2、3、6、12和24个月完成经过验证的问卷，即欧洲癌症研究与治疗组织生活质量核心问卷（EORTC QLQ-C30）和食管癌特异性问卷（QLQ-OES18）。采用线性混合效应模型来检查问卷分数随时间的变化。
术后1个月，患者的生活质量恶化，观察到的症状比基线时更多。总体健康状况、恶心和呕吐以及食管疼痛从2个月开始逐渐恢复，并在2年时恢复到初始水平。然而，术后2年时，QLQ-C30和OES18的其他功能和症状量表并未恢复正常。在比较胸骨后路径和后纵隔路径时，即使在术后2年调整混杂因素后，两组之间QLQ-OES18症状量表（如进食、吞咽困难、吞咽唾液困难、味觉问题和反流）并无差异。
胸骨后路径的颈部食管胃吻合术与后纵隔路径重建后的生活质量相当。
