Chen Chunji, Fan Xinyi, Li Bin, Hua Rong, Gu Haiyong, Guo Xufeng, Yang Yang, Li Saiqi, Sun Yifeng, Li Chunguang, Li Zhigang
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Intensive Care Unit, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Surg Oncol. 2025 May 26. doi: 10.1245/s10434-025-17516-1.
Esophagectomy with ileocolon graft (ICG) reconstruction serves as the standard surgical approach for esophageal cancer when gastric conduit (GC) is unavailable, yet comparative outcome data between these techniques remain scarce. This study evaluates survival, quality of life (QoL), and surgical risks between these approaches.
A single-center cohort compared ICG (n = 95 after propensity score matching) and GC (n = 95) in patients with esophageal cancer. Operative outcomes, complications, survival, and QoL (assessed via EORTC QLQ-C30/OES18) were analyzed.
The 3-year overall survival [hazard ratio (HR):1.26, 95% confidence interval (CI) 0.81-1.96; p = 0.47] and recurrence-free survival (HR: 1.29, 95% CI 0.85-1.95; p = 0.09) were comparable. ICG patients exhibited significantly fewer reflux symptoms (p < 0.001) and less nausea/vomiting (p = 0.017), with better QoL scores. However, ICG required longer operative times (398.2 vs. 259.3 min; p < 0.001), greater blood loss (178.9 vs. 149.5 mL; p = 0.038), and higher reoperation rates (12 vs. 2; p = 0.005). Postoperatively, ICG was associated with extended hospital stays (15.9 vs. 11.8 days; p < 0.001), increased graft necrosis (4 vs. 0; p = 0.043), and a trend toward thromboembolism (3 vs. 0; p = 0.081). The 30-day mortality (2 vs. 0; p = 0.115) and long-term complications were similar between groups.
ICG and GC offer equivalent long-term survival, but ICG reduces reflux and improves QoL despite higher perioperative complexity. ICG represents a viable alternative for esophageal reconstruction when symptom control and QoL are prioritized.
当无法使用胃代食管（GC）时，采用回结肠移植（ICG）重建的食管切除术是食管癌的标准手术方法，但这些技术之间的比较结果数据仍然很少。本研究评估了这些手术方法之间的生存率、生活质量（QoL）和手术风险。
一项单中心队列研究比较了食管癌患者中ICG组（倾向评分匹配后n = 95）和GC组（n = 95）。分析了手术结果、并发症、生存率和生活质量（通过EORTC QLQ-C30/OES18评估）。
3年总生存率[风险比（HR）：1.26，95%置信区间（CI）0.81 - 1.96；p = 0.47]和无复发生存率（HR：1.29，95% CI 0.85 - 1.95；p = 0.09）相当。ICG组患者的反流症状明显较少（p < 0.001），恶心/呕吐也较少（p = 0.017），生活质量评分更高。然而，ICG手术时间更长（398.2对259.3分钟；p < 0.001），失血量更大（178.9对149.5毫升；p = 0.038），再次手术率更高（12对2；p = 0.005）。术后，ICG与住院时间延长（15.9对11.8天；p < 0.001）、移植坏死增加（4对0；p = 0.043）以及血栓栓塞趋势增加（3对0；p = 0.081）相关。两组之间的30天死亡率（2对0；p = 0.115）和长期并发症相似。
ICG和GC提供了相当的长期生存率，但尽管围手术期复杂性更高，ICG可减少反流并改善生活质量。当优先考虑症状控制和生活质量时，ICG是食管重建的可行替代方案。
