目的:总结食管胸段癌Ivor Lewis食管切除术后胃延迟排空的防治对策。方法:回顾性分析我院3100例食管胸中下段癌行Ivor Lewis食管切除术后胃延迟排空的发生率。根据术中采取不同措施分为:A组(裂孔切开)和B组(不作裂孔切开),P组(幽门括约肌捏断)和N组(不作幽门处理),管胃组(管胃替代食管)和全胃组(全胃代食管),PM组(幽门括约肌捏断) 、PN组(不作幽门处理)和PP组(幽门成形)。比较不同处理方式前后胃延迟排空的发生率。结果:Ivor Lewis食管切除术后胃延迟排空的总的发生率为13.8%(427/3100)。术中裂孔扩大后胃延迟排空的发生率从32%(A组)降至21%(B组)(Plt;0.05);术中同时行幽门括约肌捏断后胃延迟排空的发生率从21%(N组)降至9%(P组)(Plt;0.05);采用管胃替代食管后胃延迟排空的发生率从19.5%(全胃组)降至8.3%(管胃组)(Plt;0.05);管胃组中PN组胃延迟排空的发生率为15%,PP组为8%,行幽门成形(PP组)后降至2% (Plt;0.05)。结论:胃延迟排空是Ivor Lewis食管切除术后主要的并发症,术中扩大食管裂孔、管胃替代食管和幽门成形可有效防治术后胃延迟排空的发生。
Early and mid-stage esophageal cancer can achieve a particular effect through surgeries or comprehensive treatment based on surgery. Once the esophageal cancer progresses to the advanced stage, it is still lack of effective remedy for the disease, and the patient's prognosis is poor. Immunotherapy has developed rapidly in recent years, bringing dawn to patients with advanced esophageal cancer. On July 31, 2019, the US Food and Drug Administration (FDA) approved KEYTRUDA (Merck) for the treatment of esophageal squamous cell carcinoma, and it became the first milestone drug for esophageal squamous cell carcinoma. In the paper, we will review the progress of immunotherapy in the treatment of advanced esophageal cancer on the basis of current clinical researches, which might provide ideas for further studies in the immunotherapy for esophageal cancer.
Gastroesophageal reflux (GER) is one of the most common postoperative complications in patients with esophageal cancer, which mainly manifests as heartburn sensation and acid reflux, and has a serious impact on patients' postoperative recovery and quality of life. This article reviews five aspects of postoperative reflux: main manifestations, hazards, assessment tools, influencing factors, and nonpharmacological interventions, in order to enhance the awareness of clinical healthcare professionals in recognizing and managing patients with postoperative reflux, and to provide a reference for carrying out the assessment and developing the intervention program.
Surgery following neoadjuvant therapy has become the standard treatment for middle- and late-stage resectable esophageal cancer. However, treatment modalities such as radiotherapy, chemotherapy, and surgery cause physical and psychological harm to patients, reducing their quality of life. Prehabilitation, as an emerging preoperative management strategy, integrates various measures, including exercise training, nutritional support, and psychological support. Its aim is to enhance patients’ physiological and psychological reserves prior to surgery, bolster their tolerance to surgical stress, and thus accelerate the postoperative recovery process. This approach is a key manifestation of the Enhanced Recovery After Surgery (ERAS) concept. This article reviews prehabilitation during neoadjuvant therapy for esophageal cancer patients from 3 aspects: intervention timing, intervention content, and barriers, with the aim of providing a reference for promoting early recovery in patients undergoing esophageal cancer surgery.
ObjectiveTo investigate the prognostic value and consistency of prognostic nutritional index (PNI) and patient-generated subjective global assessment (PG-SGA) in perioperative nutritional status of patients with esophageal cancer.MethodsClinical data of 224 patients, including 186 males and 38 females with an average age of 63.08±8.42 years, who underwent esophageal cancer surgery in our hospital from November 2017 to August 2018 were retrospectively reviewed. The PNI was calculated according to the results of the first time blood and biochemical tests, and the PG-SGA assessment was also performed. According to the PNI value, the patients were divided into a good nutrition group (PNI≥45, 60 patients) and a malnutrition group (PNI<45, 164 patients). According to the PG-SGA score, the patients were divided into a good nutrition group (PG-SGA<4, 75 patients) and a malnutrition group (PG-SGA≥4, 149 patients). Nutrition-related haematological indexes and body mass index (BMI) were compared between the two groups, and the consistency of PNI and PG-SGA for nutritional assessment was analyzed.ResultsThe nutrition-related haematological indexes in different PNI groups were statistically different in the perioperative period (P<0.01). The longitudinal changes of prealbumin in patients of different PG-SGA groups were statistically different (P<0.05); the BMI of patients in different PG-SGA groups was statistically different in the perioperative period (P<0.01). The Kappa coefficient of the two indicators was 0.589 (P<0.001).ConclusionBoth PNI and PG-SGA can predict the nutritional risk of patients with esophageal cancer to some extent. PNI is an objective monitoring indicator, and PG-SGA is a subjective evaluation indicator, the combined use of which can more comprehensively reflect and predict the nutritional status of patients, and provide an important reference to the development of individualized nutrition support programs.
ObjectiveTo analyze the symptom characteristics and influencing factors in order to provide reference for symptom management of patients with esophageal cancer after operation.MethodsA total of 216 esophageal cancer patients, including 180 males and 36 females with an average age of 63.7±8.3 years, who underwent surgical operation in our hospital from March to October 2018 were recruited and investigated with self-designed symptom questionnaire at 1 month after surgery.ResultsThe top five symptoms were acid reflux (48.6%), cough (42.6%), dysphagia (40.7%), hoarseness (12.0%), and diarrhea (11.6%). Women were more prone to acid reflux (OR=2.053), fatigue (OR=1.932), chest pain (OR=3.681), sleep disturbance (OR=2.419), abdominal pain (OR=3.882), nausea (OR=3.014) and vomiting (OR=2.505). Patients over 60 years were more prone to dysphagia (OR=2.274). Patients with lower thoracic esophageal cancer had a higher incidence of dysphagia compared with patients with carcinoma of esophagogastric junction (OR=0.326). Patients who had neoadjuvant chemotherapy were more likely to suffer acid reflux (OR=1.594). Open surgery (OR=3.681) and neoadjuvant radiotherapy (OR=2.495) were the risk factors of chest pain.ConclusionThere are many symptoms in patients with esophageal cancer after operation, and the occurrence of symptoms is closely related to gender, age, tumor location, surgical procedure and neoadjuvant chemoradiotherapy.
Two male patients (75 years and 51 years, respectively) suffered infection of novel coronavirus after minimally invasive surgery for esophageal squamous cell carcinoma in Sichuan Cancer Hospital since December 2022. Both patients developed severe hypoxemia after surgery, and were treated with advanced oxygen therapy, antiviral therapy, hormone shock therapy, antibiotic anti-infection and nutritional support. The two patients stayed in the intensive care unit for 6 days and 8 days respectively. They were transferred to the general ward for symptomatic treatment and were discharged successfully. Both patients required low-flow oxygen maintenance after discharge. On the 20th day of follow-up after discharge, patient 1 still needed low-flow oxygen, his oxygen saturation could be maintained above 97%, but intermittent deoxygenation could be performed for half an hour. Patient 2 was in good condition on 35 days after discharge.