食管癌的食管切除术：长期功能与生活质量

Esophageal resection for cancer of the esophagus: long-term function and quality of life.

作者信息

McLarty A J, Deschamps C, Trastek V F, Allen M S, Pairolero P C, Harmsen W S

机构信息

Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.

出版信息

Ann Thorac Surg. 1997 Jun;63(6):1568-72. doi: 10.1016/s0003-4975(97)00125-2.

DOI:10.1016/s0003-4975(97)00125-2

PMID:9205149

Abstract

BACKGROUND

Information on function and quality of life of long-term survivors after esophageal resection for carcinoma is limited.

METHODS

Between 1972 and 1990, 359 patients underwent esophagectomy for stage I or II esophageal carcinoma at Mayo Clinic. We evaluated long-term function and quality of life in 107 of these patients (81 men and 26 women) who survived 5 or more years. Median age at operation was 62 years (range, 30 to 81 years). The operation performed was an Ivor Lewis resection in 77 patients (72%), transhiatal esophagectomy in 14 (13%), extended esophagectomy in 4 (4%), thoracoabdominal esophagectomy in 4 (4%), and other in 8 (7%). Adenocarcinoma was present in 72 patients (67%), squamous cell carcinoma in 28 (26%), and other in 7 (7%). Thirty-four patients (32%) were in postsurgical stage I, 65 (61%) in stage IIA, and 8 (8%) in stage IIB. Median survival was 10.2 years (range, 5.0 to 23.2 years). Follow-up was complete for all patients.

RESULTS

Gastroesophageal reflux was present in 64 patients (60%), symptoms of dumping in 53 (50%), and dysphagia to solid food in 27 (25%). Seventeen patients (16%) were asymptomatic. Factors affecting late functional outcome were analyzed. Patients who had a cervical anastomosis had significantly fewer reflux symptoms (p < 0.05). Dumping syndrome occurred more frequently in younger patients (p < 0.05) and women (p < 0.01). Quality of life was assessed separately by the Medical Outcomes Study 36-Item Short-Form Health Survey and compared with the national norm. Scores measuring physical functioning were decreased (p < 0.01). Scores measuring ability to work, social interaction, daily activities, emotional dysfunction, perception of health, and levels of energy were similar. Mental health scores were higher (p < 0.05).

CONCLUSIONS

We conclude that long-term functional outcome after esophagectomy for esophageal carcinoma is affected by age, sex, and type of reconstruction. Quality of life as judged by the patients is similar to the national norm.

摘要

背景

关于食管癌切除术后长期存活者的功能和生活质量的信息有限。

方法

1972年至1990年间，359例患者在梅奥诊所接受了I期或II期食管癌的食管切除术。我们评估了其中107例存活5年或更长时间的患者（81名男性和26名女性）的长期功能和生活质量。手术时的中位年龄为62岁（范围30至81岁）。所施行的手术中，77例（72%）为艾弗·刘易斯切除术，14例（13%）为经裂孔食管切除术，4例（4%）为扩大食管切除术，4例（4%）为胸腹联合食管切除术，8例（7%）为其他手术。腺癌患者72例（67%），鳞状细胞癌患者28例（26%），其他类型患者7例（7%）。34例患者（32%）处于术后I期，65例（61%）处于IIA期，8例（8%）处于IIB期。中位生存期为10.2年（范围5.0至23.2年）。所有患者均完成随访。

结果

64例患者（60%）存在胃食管反流，53例（50%）有倾倒综合征症状，27例（25%）存在固体食物吞咽困难。17例患者（16%）无症状。分析了影响晚期功能结局的因素。行颈部吻合术的患者反流症状明显较少（p<0.05）。倾倒综合征在年轻患者（p<0.05）和女性患者中（p<0.01）更常见。通过医学结局研究36项简短健康调查分别评估生活质量，并与全国标准进行比较。测量身体功能的得分降低（p<0.01）。测量工作能力、社交互动、日常活动、情绪功能障碍、健康感知和能量水平的得分相似。心理健康得分较高（p<0.05）。