Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer
Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer
复制标题
DOI：
10.1111/j.1442-2050.2006.00559.x
复制
发表时间：
2006-01-01
影响因子：
2.6
通讯作者：
Shute, K.
中科院分区：
文献类型：
--
作者：
Stephens, M. R.;Lewis, W. G.;Shute, K.
我们的目的是将多学科团队 (MDT) 接受 R0 食管切除术的患者的结果与英国癌症科室独立工作的外科医生单独进行手术后的结果进行比较。历史对照组由 1991 年至 1997 年间被诊断为食管癌并由 6 名普通外科医生接受治疗性手术（54 例 R0 食管切除术）的历史对照组与 1998 年至 2003 年间接受 MDT 治疗的 67 例连续患者（53 例 R0 食管切除术，26 例接受多模式治疗）进行比较。接受开放式和封闭式剖腹手术和开胸手术的患者比例分别从对照患者的21%和5%下降至MDT患者的13%和0%（分别为chi(2) = 11.90，DF = 1，P = 0.001；chi(2) = 5.45，DF = 1，P = 0.02）。与对照患者相比，MDT 患者的手术死亡率较低（5.7% vs. 26%；chi(2) = 8.22，DF = 1，P = 0.004），并且更有可能存活 5 年（52% vs. 10%，chi(2) = 15.05，P = 0.0001）。在多变量分析中，MDT 管理（HR = 0.337，95% CI = 0.201-0.564，P < 0.001）、淋巴结转移（HR = 1.728，95% CI = 1.070-2.792，P = 0.025）和美国麻醉医师协会分级（HR = 2.207，95%） CI = 1.412-3.450，P = 0.001）与生存时间独立相关。多学科团队管理和手术亚专业化显着改善了诊断为食管癌的患者的术后结果。
We aim to compare the outcomes of patients undergoing R0 esophagectomy by a multidisciplinary team (MDT) with outcomes after surgery alone performed by surgeons working independently in a UK cancer unit. An historical control group of 77 consecutive patients diagnosed with esophageal cancer and undergoing surgery with curative intent by six general surgeons between 1991 and 1997 (54 R0 esophagectomies) were compared with a group of 67 consecutive patients managed by the MDT between 1998 and 2003 (53 R0 esophagectomies, 26 patients received multimodal therapy). The proportion of patients undergoing open and closed laparotomy and thoracotomy decreased from 21% and 5%, respectively, in control patients, to 13% and 0% in MDT patients (chi(2) = 11.90, DF = 1, P = 0.001; chi(2) = 5.45, DF = 1, P = 0.02 respectively). MDT patients had lower operative mortality (5.7%vs. 26%; chi(2) = 8.22, DF = 1, P = 0.004) than control patients, and were more likely to survive 5 years (52%vs. 10%, chi(2) = 15.05, P = 0.0001). In a multivariate analysis, MDT management (HR = 0.337, 95% CI = 0.201-0.564, P < 0.001), lymph node metastases (HR = 1.728, 95% CI = 1.070-2.792, P = 0.025), and American Society of Anesthesiologists grade (HR = 2.207, 95% CI = 1.412-3.450, P = 0.001) were independently associated with duration of survival. Multidisciplinary team management and surgical subspecialization improved outcomes after surgery significantly for patients diagnosed with esophageal cancer.