Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.
Ann Surg Oncol. 2023 Dec;30(13):8182-8191. doi: 10.1245/s10434-023-13733-8. Epub 2023 Jul 12.
Following left thoracoabdominal (LTA) esophagogastrectomy, gastrointestinal continuity can be re-established via esophagogastrostomy or esophagojejunostomy. We explored how the method of reconstruction impacted postoperative outcomes and quality of life (QoL).
From January 2007 to January 2022, patients undergoing LTA were identified from a single center's prospectively maintained database. Following esophagogastrectomy or extended total gastrectomy, an esophagogastrostomy (GAS) or Roux-en-Y esophagojejunostomy (R-Y) was fashioned. Postoperative outcomes were compared according to the method of reconstruction. The Functional Assessment of Cancer Therapy-Esophagus (FACT-E) questionnaire compared QoL.
Of the 147 LTA patients identified, 135 (92%) were included-97 GAS (72%) and 38 R-Y patients (28%). R-Y patients had more ypT3/4 lesions (97% vs. 61%, p ≤ 0.001) and a similar incidence of ypN+/M+ disease. Anastomotic leaks were more common among GAS patients (17% vs. 3%, p = 0.023), however grade 3/4 complications (26.6% vs. 19.4%, p = 0.498), reoperation, intensive care admission, hospital representation and readmission were similar. FACT-E data were available for 68/97 (70%) GAS patients and 22/38 (58%) R-Y patients, with scores for 80/21/24/18/23/24 patients at baseline/preoperatively/1 month/3-6 months/1-3 years/3+ years postoperatively, respectively. Comparing between the groups, the scores were similar at each timepoint. FACT-E improved between baseline and preoperatively (79, 34-124 vs. 102, 81-123, p = 0.027). Only at 3+ years were postoperative scores equivalent to preoperative values. GAS patients had more reflux and esophagitis >6 months postoperatively (54% vs. 13%, p = 0.048; 62% vs. 0%, p ≤ 0.001).
While the type of reconstruction did not affect QoL, it did affect the postoperative course.
左胸腹（LTA）食管胃切除术后，可通过食管胃吻合术或食管空肠吻合术重建胃肠连续性。我们探讨了重建方法对术后结果和生活质量（QoL）的影响。
自 2007 年 1 月至 2022 年 1 月，从一家单中心前瞻性维护的数据库中确定接受 LTA 的患者。在食管胃切除术后或扩大全胃切除术后，采用食管胃吻合术（GAS）或 Roux-en-Y 食管空肠吻合术（R-Y）。根据重建方法比较术后结果。癌症治疗食管功能评估量表（FACT-E）问卷比较 QoL。
在确定的 147 例 LTA 患者中，有 135 例（92%）纳入研究-97 例行 GAS（72%），38 例行 R-Y 患者（28%）。R-Y 患者的 ypT3/4 病变更多（97%比 61%，p≤0.001），ypN+/M+疾病的发生率相似。GAS 患者吻合口漏更常见（17%比 3%，p=0.023），但 3/4 级并发症（26.6%比 19.4%，p=0.498）、再次手术、重症监护病房入院、住院和再入院相似。GAS 患者可获得 68/97（70%）例和 R-Y 患者 22/38（58%）例的 FACT-E 数据，基线/术前/1 个月/3-6 个月/1-3 年/3+年后分别有 80/21/24/18/23/24 例患者的评分。与两组相比，各时间点的评分相似。FACT-E 在基线和术前之间改善（79，34-124 比 102，81-123，p=0.027）。只有在 3+年后，术后评分才相当于术前值。GAS 患者术后 6 个月以上反流和食管炎发生率更高（54%比 13%，p=0.048；62%比 0%，p≤0.001）。
虽然重建类型不影响 QoL，但会影响术后病程。
