Kim Jae Hoon, Yun Jae Kwang, Kim Chan Wook, Kim Hyeong Ryul, Kim Yong-Hee
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Colorectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Chest Surg. 2024 Jan 5;57(1):53-61. doi: 10.5090/jcs.23.074.
In the treatment of esophageal cancer, a gastric conduit is typically the first choice. However, when the stomach is not a viable option, the usual alternative is a colon conduit. This study compared the long-term surgical outcomes of gastric and colon conduits over the same interval and aimed to identify factors influencing the prognosis.
A retrospective review was conducted of patients who underwent esophagectomy followed by reconstruction for primary esophageal cancer between January 2006 and December 2020.
The study included 1,545 patients, with a gastric conduit used for 1,429 (92.5%) and a colon conduit for 116 (7.5%). Using propensity-matched analysis, 116 patients were selected from each group for comparison. No significant difference was observed in long-term survival between the gastric and colon conduit groups, irrespective of anastomosis level and pathological stage. A higher proportion of patients in the colon conduit group experienced postoperative complications compared to the gastric conduit group (57.8% vs. 25%, p<0.001). Multivariable analysis revealed that age over 65 years, body mass index below 22.0 kg/m, neoadjuvant therapy, postoperative anastomotic leakage, and renal failure were risk factors for overall survival in patients with a colon conduit. Regarding conduit-related complications, cervical anastomosis was the only significant risk factor among those with a colon conduit.
Despite the association of colon conduits with high morbidity rates relative to gastric conduits, the long-term outcomes of colon conduits were acceptable. More consideration should be given perioperatively to the use of a colon conduit, particularly in cases involving cervical anastomosis.
在食管癌治疗中，胃代食管通常是首选。然而，当胃不可用时，常用的替代方法是结肠代食管。本研究比较了胃代食管和结肠代食管在相同时间段内的长期手术效果，并旨在确定影响预后的因素。
对2006年1月至2020年12月期间接受食管癌切除并进行重建的患者进行回顾性研究。
该研究纳入1545例患者，其中1429例（92.5%）采用胃代食管，116例（7.5%）采用结肠代食管。通过倾向匹配分析，每组选取116例患者进行比较。胃代食管组和结肠代食管组的长期生存率无显著差异，无论吻合水平和病理分期如何。与胃代食管组相比，结肠代食管组术后并发症发生率更高（57.8%对25%，p<0.001）。多变量分析显示，年龄超过65岁、体重指数低于22.0 kg/m²、新辅助治疗、术后吻合口漏和肾衰竭是结肠代食管患者总生存的危险因素。关于管道相关并发症，颈部吻合是结肠代食管患者中唯一的显著危险因素。
尽管结肠代食管相对于胃代食管发病率较高，但结肠代食管的长期效果是可以接受的。围手术期应更多考虑使用结肠代食管，尤其是在涉及颈部吻合的病例中。
