手术方式对颈段食管癌术后体重及营养结局的影响

Impact of surgical approaches on postoperative body weight and nutrition outcomes in cervical esophageal cancer.

作者信息

Fuse Masahiro, Fujiwara Hisashi, Ogo Taichi, Kawada Kenro, Okuno Keisuke, Tanioka Toshiro, Haruki Shigeo, Tokunaga Masanori, Kinugasa Yusuke

机构信息

Department of Gastrointestinal Surgery, Institute of Science Tokyo, 1-5-45, Yushima, Bunkyo, Tokyo, 113-8510, Japan.

出版信息

Esophagus. 2025 Sep 2. doi: 10.1007/s10388-025-01151-6.

DOI:10.1007/s10388-025-01151-6

PMID:40892350

Abstract

BACKGROUND

Cervical esophageal cancer surgery can lead to postoperative gastric issues, impairing nutritional quality of life. This study aimed to compare larynx-preserving cervical esophagectomy with free jejunal graft interposition and subtotal esophagectomy with gastric pull-up reconstruction in terms of both short-term and long-term outcomes, with a particular focus on short-term nutritional parameters.

METHODS

This single-institution, retrospective study included 87 patients who underwent surgery for cervical esophageal cancer between January 2011 and December 2021. Patient characteristics and postoperative outcomes were analyzed to compare larynx-preserving cervical esophagectomy with free jejunal graft interposition (CE group, n = 26) and subtotal esophagectomy with gastric pull-up reconstruction (SE group, n = 61); furthermore, nutritional parameters were analyzed in patients from both groups who could be followed up for > 1 year postoperatively (nutritional CE group, n = 20; nutritional SE group, n = 41).

RESULTS

Demographic differences between the CE and SE groups were not significant. The postoperative complication rates, length of hospital stay, and mortality rates were similar between the groups. Survival analysis showed no significant differences in 5-year overall survival (69.2% vs. 62.8%, p = 0.554) or recurrence-free survival (54.5% vs. 55.7%, p = 0.933) between the nutritional CE and SE groups. Changes in bodyweight and Onodera's prognostic nutritional index were less negative in the nutritional CE group (-0.4% vs. -15.2%, p < 0.001, and 0.68% vs. -2.68%, p = 0.028, respectively).

CONCLUSION

Larynx-preserving cervical esophagectomy with free jejunal graft interposition has a significant advantage in improving postoperative nutritional status without increasing complications or compromising long-term outcomes, compared to subtotal esophagectomy with gastric pull-up reconstruction. Therefore, it is a viable initial surgical option for patients with resectable cervical esophageal cancer who are candidates for radical resection with cervical esophagectomy alone.

摘要

背景

颈段食管癌手术可导致术后胃部问题，损害营养生活质量。本研究旨在比较保留喉功能的颈段食管切除术联合游离空肠移植术与次全食管切除术联合胃上提重建术在短期和长期预后方面的差异，特别关注短期营养参数。

方法

这项单中心回顾性研究纳入了2011年1月至2021年12月期间接受颈段食管癌手术的87例患者。分析患者特征和术后结局，以比较保留喉功能的颈段食管切除术联合游离空肠移植术（CE组，n = 26）和次全食管切除术联合胃上提重建术（SE组，n = 61）；此外，对两组术后可随访超过1年的患者（营养CE组，n = 20；营养SE组，n = 41）的营养参数进行分析。

结果

CE组和SE组的人口统计学差异不显著。两组的术后并发症发生率、住院时间和死亡率相似。生存分析显示，营养CE组和SE组的5年总生存率（69.2%对62.8%，p = 0.554）或无复发生存率（54.5%对55.7%，p = 0.933）无显著差异。营养CE组的体重变化和小野寺预后营养指数的负值较小（分别为-0.4%对-15.2%，p < 0.001，以及0.68%对-2.68%，p = 0.028）。