Long-Term Outcomes of Colon Conduits in Surgery for Primary Esophageal Cancer: A Propensity Score-Matched Comparison to Gastric Conduits.

Q4 Medicine Journal of Chest Surgery Pub Date : 2024-01-05 DOI:10.5090/jcs.23.074
Jae Hoon Kim, Jae Kwang Yun, Chan Wook Kim, Hyeong Ryul Kim, Yong-Hee Kim
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Abstract

Background: In the treatment of esophageal cancer, a gastric conduit is typically the first choice. However, when the stomach is not a viable option, the usual alternative is a colon conduit. This study compared the long-term surgical outcomes of gastric and colon conduits over the same interval and aimed to identify factors influencing the prognosis.

Methods: A retrospective review was conducted of patients who underwent esophagectomy followed by reconstruction for primary esophageal cancer between January 2006 and December 2020.

Results: The study included 1,545 patients, with a gastric conduit used for 1,429 (92.5%) and a colon conduit for 116 (7.5%). Using propensity-matched analysis, 116 patients were selected from each group for comparison. No significant difference was observed in long-term survival between the gastric and colon conduit groups, irrespective of anastomosis level and pathological stage. A higher proportion of patients in the colon conduit group experienced postoperative complications compared to the gastric conduit group (57.8% vs. 25%, p<0.001). Multivariable analysis revealed that age over 65 years, body mass index below 22.0 kg/m2, neoadjuvant therapy, postoperative anastomotic leakage, and renal failure were risk factors for overall survival in patients with a colon conduit. Regarding conduit-related complications, cervical anastomosis was the only significant risk factor among those with a colon conduit.

Conclusion: Despite the association of colon conduits with high morbidity rates relative to gastric conduits, the long-term outcomes of colon conduits were acceptable. More consideration should be given perioperatively to the use of a colon conduit, particularly in cases involving cervical anastomosis.

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原发性食管癌手术中结肠导管的长期疗效:与胃导管的倾向得分匹配比较。
背景:在食管癌的治疗中,胃导管通常是首选。然而,当胃不可行时,通常会选择结肠导管。本研究比较了胃导管和结肠导管在相同时间间隔内的长期手术效果,旨在找出影响预后的因素:方法:对 2006 年 1 月至 2020 年 12 月间因原发性食管癌接受食管切除术和重建术的患者进行回顾性研究:研究共纳入 1,545 例患者,其中 1,429 例(92.5%)使用胃导管,116 例(7.5%)使用结肠导管。通过倾向匹配分析,从每组中选择了 116 名患者进行比较。无论吻合水平和病理分期如何,胃导管组和结肠导管组的长期生存率均无明显差异。与胃导管组相比,结肠导管组中出现术后并发症的患者比例更高(57.8% 对 25%,P2),新辅助治疗、术后吻合口漏和肾功能衰竭是影响结肠导管患者总生存率的风险因素。关于导管相关并发症,宫颈吻合术是结肠导管患者中唯一显著的风险因素:结论:尽管与胃导管相比,结肠导管的发病率较高,但结肠导管的长期疗效是可以接受的。在围手术期应更多地考虑使用结肠导管,尤其是在涉及宫颈吻合术的病例中。
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来源期刊
Journal of Chest Surgery
Journal of Chest Surgery Medicine-Surgery
CiteScore
0.80
自引率
0.00%
发文量
76
审稿时长
7 weeks
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