Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Department of Next-Generation Surgical Therapy Development, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Langenbecks Arch Surg. 2020 Dec;405(8):1111-1118. doi: 10.1007/s00423-020-01969-x. Epub 2020 Aug 29.
Advanced esophageal cancer often results in esophageal stenosis or tracheoesophageal fistula. Esophageal bypass surgery and esophageal stent insertion are palliative treatments for esophageal cancer. With improvements in metallic stents and the stent insertion technique, esophageal stent insertion appears to be performed more frequently than bypass surgery, worldwide. The aim of this study was to evaluate the outcomes of bypass surgery and stent insertion in our hospital and reevaluate which patients would benefit from bypass surgery.
A total of 70 esophageal cancer patients who could not tolerate oral feeding due to esophageal stenosis or tracheoesophageal fistula underwent palliative treatment [esophageal bypass surgery (N = 34) and esophageal stent insertion (N = 36)] at Kumamoto University. We retrospectively investigated the clinicopathological factors, postoperative outcomes, and complications.
Both treatments could significantly improve the amount of food intake and the dietary form (P < 0.01). The length of hospital stay was shorter (P < 0.01) and complications associated with treatment were reduced in the stent group (P = 0.03). The overall survival did not differ significantly between the groups (log rank P = 0.22). Importantly, in the bypass surgery group, the patients who received postoperative treatment had a better prognosis than those who did not receive postoperative treatment (log rank P < 0.01).
Both bypass surgery and stent insertion allowed oral intake in patients who could not tolerate oral feeding because of esophageal stenosis or tracheoesophageal fistula. Considering that patients who undergo stent insertion have a shorter hospital stay and fewer complications, stent insertion may be a better first choice for treatment than bypass surgery. However, bypass surgery may be an option for patients who can tolerate postoperative treatment.
晚期食管癌常导致食管狭窄或食管气管瘘。食管旁路手术和食管支架置入术是食管癌的姑息性治疗方法。随着金属支架和支架置入技术的改进，全球范围内食管支架置入术的应用似乎比旁路手术更为频繁。本研究旨在评估我院旁路手术和支架置入术的治疗效果，并重新评估哪些患者可从旁路手术中获益。
70 例因食管狭窄或食管气管瘘而无法经口进食的食管癌患者在熊本大学接受姑息性治疗[食管旁路手术（n=34）和食管支架置入术（n=36）]。我们回顾性调查了患者的临床病理因素、术后结果和并发症。
两种治疗方法均可显著改善患者的进食量和饮食方式（P<0.01）。支架组的住院时间更短（P<0.01），且与治疗相关的并发症减少（P=0.03）。两组患者的总生存时间无显著差异（log rank P=0.22）。重要的是，在旁路手术组中，接受术后治疗的患者预后优于未接受术后治疗的患者（log rank P<0.01）。
旁路手术和支架置入术均可使因食管狭窄或食管气管瘘而无法经口进食的患者恢复经口进食。考虑到支架置入组患者的住院时间更短，并发症更少，支架置入术可能是比旁路手术更好的治疗选择。然而，对于能够耐受术后治疗的患者，旁路手术可能是一种选择。
