食管癌切除术后吞咽困难患者的危险因素及术后长期结局
Risk factors and long-term postoperative outcomes in patients with postoperative dysphagia after esophagectomy for esophageal cancer.
作者信息
Sugase Takahito, Miyata Hiroshi, Sugimura Keijiro, Kanemura Takashi, Takeoka Tomohira, Yamamoto Masaaki, Shinno Naoki, Hara Hisashi, Omori Takeshi, Yano Masahiko
机构信息
Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan.
出版信息
Ann Gastroenterol Surg. 2022 Mar 15;6(5):633-642. doi: 10.1002/ags3.12566. eCollection 2022 Sep.
AIM
Dysphagia is one of the most common complications after esophagectomy. However, no study has investigated the long-term postoperative outcomes in patients with postoperative dysphagia. Here, we aimed to identify risk factors for postoperative dysphagia and to investigate long-term postoperative outcomes in such patients.
METHODS
This study included 304 consecutive patients with thoracic esophageal cancer who underwent curative esophagectomy. They were diagnosed with postoperative dysphagia through a contrast videofluoroscopic swallowing study, and postoperative outcomes were compared based on swallowing function.
RESULTS
In total, 112 patients (37%) were diagnosed with postoperative dysphagia. Older age, low BMI, and recurrent laryngeal nerve palsy were identified as independent risk factors for postoperative dysphagia. In the dysphagia group, a significantly larger number of patients developed in-hospital pneumonia, and hospital stays were also significantly extended. After discharge, 37 (33%) patients with postoperative dysphagia developed pneumonia. Even more than 1 year after esophagectomy, a significantly larger number of patients (24 patients, 21%) with postoperative dysphagia developed pneumonia compared to those without postoperative dysphagia. Postoperative dysphagia was identified as an independent risk factor for out-of-hospital pneumonia. Regarding nutritional status, there was no difference in weight loss 1 year after esophagectomy, but significant weight loss was observed 2 years after esophagectomy in the dysphagia group.
CONCLUSION
Postoperative dysphagia was associated with both preoperative patient factors and surgical factors. Moreover, patients with postoperative dysphagia had long-term and short-term pneumonia risk. The personalization of long-term follow-up through more aggressive rehabilitation and nutritional guidance is required for patients with postoperative dysphagia.
目的
吞咽困难是食管切除术后最常见的并发症之一。然而，尚无研究调查术后吞咽困难患者的长期术后结局。在此，我们旨在确定术后吞咽困难的危险因素，并调查此类患者的长期术后结局。
方法
本研究纳入了304例连续接受根治性食管切除术的胸段食管癌患者。通过吞咽造影检查诊断为术后吞咽困难，并根据吞咽功能比较术后结局。
结果
共有112例患者（37%）被诊断为术后吞咽困难。年龄较大、体重指数较低和喉返神经麻痹被确定为术后吞咽困难的独立危险因素。在吞咽困难组中，发生院内肺炎的患者数量显著更多，住院时间也显著延长。出院后，37例（33%）术后吞咽困难患者发生肺炎。即使在食管切除术后1年多，与无术后吞咽困难的患者相比，术后吞咽困难的患者发生肺炎的数量仍显著更多（24例，21%）。术后吞咽困难被确定为院外肺炎的独立危险因素。关于营养状况，食管切除术后1年体重减轻情况无差异，但吞咽困难组在食管切除术后2年观察到显著体重减轻。
结论
术后吞咽困难与术前患者因素和手术因素均相关。此外，术后吞咽困难患者有长期和短期肺炎风险。对于术后吞咽困难患者，需要通过更积极的康复和营养指导进行长期随访的个性化治疗。
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