算法方法结合负压伤口疗法提高了接受胃管重建咽胃切除术的同时患有咽和食管恶性肿瘤患者的存活率。

Algorithmic Approach Using Negative Pressure Wound Therapy Improved Survival for Patients with Synchronous Hypopharyngeal and Esophageal Cancer Undergoing Pharyngolaryngoesophagectomy with Gastric Tube Reconstruction.

机构信息

Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.

Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.

出版信息

Ann Surg Oncol. 2021 Dec;28(13):8996-9007. doi: 10.1245/s10434-021-10365-8. Epub 2021 Sep 28.

DOI:10.1245/s10434-021-10365-8

PMID:34585295

Abstract

BACKGROUND

This study retrospectively analyzed the feasibility and surgical outcome of an algorithmic approach using negative pressure wound therapy for patients with synchronous hypopharyngeal and esophageal cancer undergoing pharyngolaryngoesophagectomy with gastric tube reconstruction.

METHODS

Patients undergoing pharyngolaryngoesophagectomy and gastric tube reconstruction for hypopharyngeal cancer between 2011 and 2019 were candidates for this study. Data were collected on patient demographics, comorbidities, performance status, cancer stage, treatment, complication, and survival. Survival analysis was performed using the Kaplan-Meier method. The Cox proportional hazards model was used for prognostic factors.

RESULTS

The study enrolled 43 patients. Anastomotic leakage was found in 21 of the patients with a conventional surgical drain (61.9%) and in 10 of the 22 patients with negative pressure wound therapy (45.5%) (p = 0.280). Nine patients in the conventional drain group (42.9%) and two patients in the negative pressure wound therapy group (9.1%) had leakage-associated complications (p = 0.011). The incidence of pulmonary complications was higher in the conventional surgical drain group (9 vs 2; p = 0.011). The number of complications requiring surgery was higher in the conventional drain group (7 vs 0; p = 0.004). The overall survival in the negative pressure wound therapy group was better (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.15-0.76; p = 0.009). Negative pressure wound therapy was independently associated with overall survival (HR, 0.31; 95% CI, 0.13-0.77; p = 0.011).

CONCLUSIONS

Negative pressure wound therapy with an algorithmic approach improved the overall survival for the patients undergoing gastric tube reconstruction after pharyngolaryngoesophagectomy for hypopharyngeal and esophageal cancer by preventing deadly complications secondary to anastomotic leakage.

摘要

背景

本研究回顾性分析了一种算法策略，即使用负压伤口疗法治疗同时患有下咽和食管癌症并接受咽胃切除术和胃管重建的患者的可行性和手术结果。

方法

2011 年至 2019 年间接受咽胃切除术和胃管重建治疗下咽癌的患者符合本研究条件。收集患者人口统计学、合并症、表现状态、癌症分期、治疗、并发症和生存数据。使用 Kaplan-Meier 方法进行生存分析。使用 Cox 比例风险模型进行预后因素分析。

结果

本研究共纳入 43 例患者。21 例常规手术引流患者（61.9%）和 22 例负压伤口治疗患者（45.5%）中发现吻合口漏（p = 0.280）。常规引流组中有 9 例患者（42.9%）和负压伤口治疗组中有 2 例患者（9.1%）发生与漏相关的并发症（p = 0.011）。常规手术引流组的肺部并发症发生率较高（9 例比 2 例；p = 0.011）。常规引流组需要手术治疗的并发症数量较高（7 例比 0 例；p = 0.004）。负压伤口治疗组的总生存率较好（风险比 [HR]，0.33；95%置信区间 [CI]，0.15-0.76；p = 0.009）。负压伤口治疗与总生存率独立相关（HR，0.31；95%CI，0.13-0.77；p = 0.011）。