Uneeb Muhammad, Yusufi Maaz A, Khan Hadi M, Khan Murad A, Khan Alishbah, Iqbal Hania
General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK.
Surgery, University Hospitals Dorset, Poole, GBR.
Cureus. 2025 Jul 6;17(7):e87366. doi: 10.7759/cureus.87366. eCollection 2025 Jul.
Esophageal cancer (EC) is a disease with a poor prognosis. Surgical management, combined with chemoradiotherapy, is the standard management. However, esophagectomy is associated with high morbidity and mortality. There is limited data on esophagectomy and its outcomes in Pakistan. This study aims to address this gap in the literature.
A retrospective single-center cohort study was conducted to evaluate patients undergoing esophagectomy for EC during five years, from January 1, 2019, to December 31, 2023. Patients underwent minimally invasive esophagectomy in the form of laparoscopic-assisted Ivor-Lewis esophagectomy, or open surgery, as left thoracoabdominal esophagectomy and transhiatal esophagectomy. Data regarding intraoperative course, postoperative events, complications, and final histopathology reports were evaluated.
A total of 43 patients underwent esophagectomy for EC. The mean age was 62.2 ± 12.1 years, with 31 (72.1%) male patients. Adenocarcinoma was the most common diagnosis, accounting for 27 (62.8%), with squamous cell carcinoma present in the remaining 16 (37.2%) cases. Neoadjuvant therapy was given to 37 (86.0%) patients. Mean operative time was 288 ± 88 minutes. Twenty-six (60.5%) patients had an uneventful postoperative course. Seven (16.3%) patients experienced minor deviations from the routine postoperative course and were classified as grade 1 in the Clavien-Dindo classification. Higher Clavien-Dindo grades were found in 12 (27.9%) cases, indicating greater morbidity. There were no cases of anastomotic leak or chyle leak. There was one reintervention (2.3%) and one mortality (2.3%). There was no association between the development of complications and gender (= 0.245), presence of comorbidities (= 0.224), or the histopathological diagnosis (= 0.555). The majority of cases were T3 tumors, accounting for 21 (48.8%), while the most common grade was grade 2, with 25 (58.1%) cases. Lymph node involvement was absent in 17 (39.5%) patients. The most common final stage was IIIb, found in 19 (44.2%) cases. R0 resection was achieved in 36 (83.7%).
Esophagectomy with reasonable rates of morbidity and sound oncological outcomes is feasible in a developing country like Pakistan. Complications were found to be independent of gender, comorbidities, and the underlying pathology. Larger, prospective, and ideally multicenter studies with a longer follow-up period are needed from this region.
食管癌（EC）是一种预后较差的疾病。手术治疗联合放化疗是标准治疗方法。然而，食管切除术的发病率和死亡率较高。关于巴基斯坦食管切除术及其结果的数据有限。本研究旨在填补文献中的这一空白。
进行了一项回顾性单中心队列研究，以评估2019年1月1日至2023年12月31日这五年间因食管癌接受食管切除术的患者。患者接受了以腹腔镜辅助艾弗-刘易斯食管切除术形式的微创食管切除术，或开放手术，如左胸腹联合食管切除术和经裂孔食管切除术。评估了术中过程、术后事件、并发症和最终组织病理学报告的数据。
共有43例患者因食管癌接受了食管切除术。平均年龄为62.2±12.1岁，男性患者31例（72.1%）。腺癌是最常见的诊断，占27例（62.8%），其余16例（37.2%）为鳞状细胞癌。37例（86.0%）患者接受了新辅助治疗。平均手术时间为288±88分钟。26例（60.5%）患者术后过程顺利。7例（16.3%）患者术后过程与常规情况有轻微偏差，在Clavien-Dindo分类中被归类为1级。12例（27.9%）患者出现更高的Clavien-Dindo分级，表明发病率更高。没有吻合口漏或乳糜漏的病例。有1例再次干预（2.3%）和1例死亡（2.3%）。并发症的发生与性别（P=0.245）、合并症的存在（P=0.224）或组织病理学诊断（P=0.555）之间没有关联。大多数病例为T3肿瘤，占21例（48.8%），而最常见的分级为2级，有25例（58.1%）。17例（39.5%）患者无淋巴结受累。最常见的最终分期为IIIb期，有19例（44.2%）。36例（83.7%）实现了R0切除。
在巴基斯坦这样的发展中国家，食管切除术具有合理的发病率和良好的肿瘤学结果是可行的。发现并发症与性别、合并症和潜在病理无关。该地区需要开展更大规模、前瞻性且理想情况下为多中心且随访期更长的研究。
