Postoperative respiratory morbidity can adversely affect prognosis in thoracoscopic esophagectomy for esophageal cancer: a retrospective study
Postoperative respiratory morbidity can adversely affect prognosis in thoracoscopic esophagectomy for esophageal cancer: a retrospective study
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DOI：
10.1007/s00464-022-09711-y
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发表时间：
2022-10-31
影响因子：
3.1
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Horinouchi, Tomo;Yoshida, Naoya;Baba, Hideo
食管癌的食管切除术与频繁的呼吸系统疾病相关，这可能会降低术后生存结果。胸腔镜食管切除术（TE）的侵入性较小，与开放式食管切除术相比，呼吸系统发病率更低。然而，te后呼吸道发病率与预后之间的关系尚未得到很好的确定。方法：本研究纳入了2011年5月至2020年11月期间接受TE治疗的食管癌患者378例。根据有无呼吸道疾病将患者分为两组。回顾性比较两组的短期和长期结果。结果呼吸系统疾病与既往重度吸烟习惯（Brinkman指数，p = 0.0039）、戒烟时间短（p = 0.0012）、较差的美国麻醉医师身体状况（p = 0.016）、频繁的心血管共病（p = 0.0085）、住院时间长（p < 0.001）有显著相关性。呼吸系统疾病显著恶化了总生存期（OS） （p = 0.011）和无复发生存期（p = 0.062），并可能与临床分期一起成为OS的独立预后因素（风险比= 1.90,95%可信区间= 1.093-3.311,p = 0.023）。结论呼吸道疾病对TE术后预后有不利影响。为了改善TE治疗食管癌的短期和长期预后，需要采取各种预防呼吸系统疾病的措施。
Background Esophagectomy for esophageal cancer is associated with frequent respiratory morbidities, which may deteriorate postoperative survival outcomes. Thoracoscopic esophagectomy (TE) is less invasive and is associated with fewer respiratory morbidities than open esophagectomy. However, the relationship between post-TE respiratory morbidity and prognosis has not been well established. Methods This study included 378 patients who underwent TE for esophageal cancer between May 2011 and November 2020. Patients were divided into two groups based on the presence of respiratory morbidity. Short-term and long-term outcomes of the groups were retrospectively compared. Results Respiratory morbidity was significantly associated with heavy past smoking habits (Brinkman index, p = 0.0039), short duration of smoking cessation (p = 0.0012), worse American Society of Anesthesiologists physical status (p = 0.016), frequent cardiovascular comorbidities (p = 0.0085), and long hospital stay (p < 0.001). Respiratory morbidity significantly deteriorated overall survival (OS) (p = 0.011) and relapse-free survival (p = 0.062) and could be an independent prognostic factor for OS (hazard ratio = 1.90, 95% confidence interval = 1.093-3.311, p = 0.023) along with clinical stage. Conclusion Respiratory morbidity can adversely affect prognosis after TE. Various prophylaxes for respiratory morbidity are required to improve the short-term and long-term outcomes of TE for esophageal cancer.