Diseases of the Esophagus最新文献_第7页

Western European Variation in the Organization of Esophageal Cancer Surgical Care 西欧食管癌外科治疗组织的差异

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2024-04-27 DOI: 10.1093/dote/doae033

Maurits R Visser, Daan M Voeten, Suzanne S Gisbertz, Jelle P Ruurda, Michael P Achiam, Magnus Nilsson, Sheraz R Markar, Manuel Pera, Riccardo Rosati, Guillaume Piessen, Philippe Nafteux, Christian A Gutschow, Peter P Grimminger, Jari V Räsänen, John V Reynolds, Hans-Olaf Johannessen, Pedro Vieira, Michael Weitzendorfer, Aristotelis Kechagias, Mark I van Berge Henegouwen, Richard van Hillegersberg

Reasons for structural and outcome differences in esophageal cancer surgery in Western Europe remain unclear. This questionnaire study aimed to identify differences in the organization of esophageal cancer surgical care in Western Europe. A cross-sectional international questionnaire study was conducted among upper gastrointestinal (GI) surgeons from Western Europe. One surgeon per country was selected based on scientific output and active membership in the European Society for Diseases of the Esophagus or (inter)national upper GI committee. The questionnaire consisted of 51 structured questions on the structural organization of esophageal cancer surgery, surgical training, and clinical audit processes. Between October 2021 and October 2022, 16 surgeons from 16 European countries participated in this study. In 5 countries (31%), a volume threshold was present ranging from 10 to 26 annual esophagectomies, in 7 (44%) care was centralized in designated centers, and in 4 (25%) no centralizing regulations were present. The number of centers performing esophageal cancer surgery per country differed from 4 to 400, representing 0.5–4.9 centers per million inhabitants. In 4 countries (25%), esophageal cancer surgery was part of general surgical training and 8 (50%) reported the availability of upper GI surgery fellowships. A national audit for upper GI surgery was present in 8 (50%) countries. If available, all countries use the audit to monitor the quality of care. Substantial differences exist in the organization and centralization of esophageal cancer surgical care in Western Europe. The exchange of experience in the organizational aspects of care could further improve the results of esophageal cancer surgical care in Europe.

西欧食管癌手术结构和结果存在差异的原因尚不清楚。这项问卷调查研究旨在确定西欧食管癌手术治疗组织方面的差异。我们对西欧的上消化道（GI）外科医生进行了一项横断面国际问卷调查。根据科研成果和欧洲食管疾病学会或（国家间）上消化道委员会的活跃成员资格，每个国家选出一名外科医生。问卷由 51 个结构化问题组成，内容涉及食管癌手术的结构组织、手术培训和临床审核流程。2021 年 10 月至 2022 年 10 月期间，来自 16 个欧洲国家的 16 名外科医生参与了这项研究。有 5 个国家（31%）规定了年食管切除术量阈值，从 10 例到 26 例不等；有 7 个国家（44%）在指定中心集中进行治疗；有 4 个国家（25%）没有集中规定。每个国家进行食管癌手术的中心数量从 4 到 400 不等，即每百万居民有 0.5 到 4.9 个中心。在 4 个国家（25%），食管癌手术是普通外科培训的一部分，8 个国家（50%）报告有上消化道外科奖学金。有 8 个国家（50%）对上消化道手术进行了国家审计。如果有的话，所有国家都使用审计来监控医疗质量。西欧国家在食道癌外科治疗的组织和集中化方面存在很大差异。交流医疗组织方面的经验可进一步提高欧洲食管癌手术治疗的效果。

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引用次数: 0

Metabolic dysfunction-associated steatotic liver disease and risk of esophageal cancer in patients with diabetes mellitus: a nationwide cohort study 代谢功能障碍相关脂肪性肝病与糖尿病患者罹患食管癌的风险：一项全国性队列研究

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2024-04-08 DOI: 10.1093/dote/doae029

Yeong Jeong Jeon, Kyungdo Han, Seung Woo Lee, Ji Eun Lee, Junhee Park, In Young Cho, Jong Ho Cho, Dong Wook Shin

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with type 2 diabetes and a developing several cancers including esophageal cancer (EC). However, the association between MASLD and EC in diabetic patients has not been investigated. Therefore, we aimed to investigate the relation between MASLD and developing EC in diabetic patients. This was a population-based retrospective cohort study of data from the Korean National Health Insurance Service (NHIS). A total of 1,904,468 subjects diagnosed with diabetes who underwent NHIS-provided health checkups from 2009 to 2012 were included. We constructed a Cox proportional hazard model for the association of fatty liver index (FLI) and the risk of EC stratified by potential confounders. Over a mean follow-up duration of 6.9 years, the incidence of EC was higher in the high (≥60) FLI group compared to the low (<30) FLI group (14.4 vs. 13.7 event per 100,000 person-years). The risk of EC correlated with the degree of FLI, particularly in older (P = 0.002), female (P = 0.033), non-smoking (P = 0.002), and non-drinking patients (P = 0.025). Among obese patients, the risk of EC was not associated with FLI; however, the risk of EC was higher in the high FLI group in non-obese patients. Lean MASLD patients had the highest risk of EC (adjusted hazard ratio 1.78; 95% confidence interval, 1.5–2.13). MASLD was associated with an increased risk of EC in diabetic patients, and lean MASLD has the highest risk. Further studies are required to determine the causal relationship between MASLD and EC.

代谢功能障碍相关性脂肪性肝病（MASLD）与 2 型糖尿病和包括食管癌在内的多种癌症的发病密切相关。然而，糖尿病患者的代谢功能障碍相关性脂肪性肝病与食管癌之间的关系尚未得到研究。因此，我们旨在研究糖尿病患者的MASLD与食管癌之间的关系。这是一项基于人群的回顾性队列研究，研究数据来自韩国国民健康保险服务（NHIS）。共纳入了1,904,468名确诊为糖尿病的受试者，这些受试者在2009年至2012年期间接受了NHIS提供的健康检查。我们针对脂肪肝指数（FLI）与EC风险之间的关系构建了一个Cox比例危险模型，并对潜在的混杂因素进行了分层。在平均6.9年的随访期间，高（≥60）脂肪肝指数组与低（<30）脂肪肝指数组相比，EC发病率更高（每10万人年14.4例与13.7例）。心肌梗死的风险与FLI程度相关，尤其是年龄较大（P = 0.002）、女性（P = 0.033）、不吸烟（P = 0.002）和不饮酒（P = 0.025）的患者。在肥胖患者中，发生心肌梗死的风险与FLI无关；但在非肥胖患者中，高FLI组发生心肌梗死的风险较高。瘦型MASLD患者的EC风险最高（调整后危险比为1.78；95%置信区间为1.5-2.13）。MASLD与糖尿病患者发生心肌梗死的风险增加有关，而瘦型MASLD的风险最高。要确定MASLD与EC之间的因果关系，还需要进一步研究。

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引用次数: 0

The effect of aging on short- and long-term results after esophagectomy: an international multicenter retrospective analysis. 衰老对食管切除术后短期和长期疗效的影响：一项国际多中心回顾性分析

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2024-01-31 DOI: 10.1093/dote/doad057

Valentina Mengardo, Jacopo Weindelmayer, Giovanni Ceccherini, Michelle Wilkinson, Giovanni de Manzoni, William Allum, Simone Giacopuzzi

The optimal treatment for esophageal cancer in elderly patients is still debated and data on postoperative results are limited. This retrospective international study aims to clarify the impact of age on clinical and oncological outcomes after esophagectomy. All patients that underwent esophagectomy for cancer between 2007 and 2016 at two European high-volume Centers have been included in the study. Patients were divided into three groups according to their age: young-age group (YAG) (18-69), middle-age group (70-74) and old-age group (>74). Primary outcome was 5-year overall survival (OS), while secondary outcomes considered were 5-year disease free survival and disease related survival, 90-day morbidity and mortality, readmission rate and radicality. A total of 575 patients were included. No differences emerged in terms of morbidity and length of stay, while mortality increased with aging from 2% in YAG to 4.8% in old-aged (P = 0.003). Old-age patients had less neoadjuvant treatment (P < 0.001), a less aggressive mediastinal lymphadenectomy and presented a more advanced pathological stage. As expected, OS decreased significantly for older patients compared with the other two age groups (P = 0.044) but, on the other hand, disease free and disease related survival were comparable between the groups. Age itself should not be considered a contraindication to esophagectomy. Although in patients older than 75 years postoperative mortality is significantly increased, esophagectomy could be still an option in selected patients, favoring the use of minimally invasive techniques and enhanced recovery protocols.

老年食管癌患者的最佳治疗方法仍有争议，术后结果数据有限。这项回顾性国际研究旨在阐明年龄对食管切除术后临床和肿瘤预后的影响。2007年至2016年期间在两个欧洲大容量中心接受食管癌切除术的所有患者都被纳入该研究。患者按年龄分为青壮年组(YAG)(18 ~ 69岁)、中年组(70 ~ 74岁)和老年组(> ~ 74岁)。主要结局是5年总生存期(OS)，次要结局是5年无病生存期和疾病相关生存期、90天发病率和死亡率、再入院率和根治性。共纳入575例患者。发病率和住院时间方面没有差异，而死亡率随着年龄的增长而增加，从青年组的2%增加到老年组的4.8% (P = 0.003)。老年患者的新辅助治疗较少(P < 0.001)，纵隔淋巴结切除术的侵袭性较小，病理分期更晚。正如预期的那样，与其他两个年龄组相比，老年患者的OS显着下降(P = 0.044)，但另一方面，两组之间的无病生存率和疾病相关生存率具有可比性。年龄本身不应被视为食道切除术的禁忌症。尽管75岁以上的患者术后死亡率显著增加，但在某些患者中，食管切除术仍然是一种选择，更倾向于使用微创技术和增强恢复方案。

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引用次数: 0

Comparing clinical outcomes of peroral endoscopic myotomy for achalasia between Eastern and Western countries: a systematic review and meta-analysis. 比较东西方国家经口内窥镜下肌切开术治疗贲门失弛缓症的临床结果:一项系统回顾和荟萃分析

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2024-01-31 DOI: 10.1093/dote/doad056

Han Zhang, Xinxin Pu, Shu Huang, Huifang Xia, Kang Zou, Xinyi Zeng, Jiao Jiang, Wensen Ren, Yan Peng, Muhan Lü, Xiaowei Tang

Peroral endoscopic myotomy (POEM) has revolutionized the therapeutic strategy for achalasia with promising results. We conducted this meta-analysis to compare clinical outcomes between Eastern and Western countries. A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science and Cochrane Library databases to query for studies that assessed the efficacy of POEM for achalasia. All articles published from inception to December 31, 2021 were included. The primary outcome was the pooled clinical success rate. The secondary outcomes included the pooled technical success rate, incidence of adverse events, procedure time and hospital stay. Eighteen Eastern studies involving 5962 patients and 11 Western studies involving 1651 patients were included. The pooled clinical success rate and technical success rate for POEM was equal in the Eastern studies compared to Western studies. The pooled incidence of procedure adverse events for POEM was a little lower in the Eastern studies compared to Western studies (6.6% vs. 8.7%). Similarly, the incidence of reflux-related adverse events was lower in Eastern studies than that in Western studies. The pooled procedure time of POEM was shorter in Eastern studies compared to Western studies (61 minutes vs. 80 minutes), while the length of hospital stay was longer in Eastern studies compared to Western studies (5.8 days vs. 2.4 days). Overall, Eastern countries have the similar POEM outcomes compared to Western countries. However, Eastern countries still need to do more to reduce the length of hospital stay.

经口内镜肌切开术（POEM）彻底改变了贲门失弛缓症的治疗策略，取得了良好的效果。我们进行了这项荟萃分析，以比较东西方国家的临床结果。在PubMed、EMBASE、Web of Science和Cochrane Library数据库中进行了全面的文献检索，以查询评估POEM治疗贲门失弛缓症疗效的研究。收录了从创刊到2021年12月31日发表的所有文章。主要结果是合并的临床成功率。次要结果包括合并技术成功率、不良事件发生率、手术时间和住院时间。包括18项涉及5962名患者的东方研究和11项涉及1651名患者的西方研究。与西方研究相比，东方研究中POEM的综合临床成功率和技术成功率相等。与西方研究相比，东方研究中POEM手术不良事件的合并发生率略低（6.6%vs.8.7%）。同样，东方研究的反流相关不良事件发生率低于西方研究。与西方研究相比，东方研究的POEM合并手术时间更短（61分钟对80分钟），而与西方研究（5.8天对2.4天）相比，东方国家的住院时间更长。总体而言，东方国家与西方国家的POEM结果相似。然而，东方国家仍然需要做更多的工作来缩短住院时间。

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引用次数: 0

Are the Chicago 3.0 manometric diagnostics consistent with Chicago 4.0? 芝加哥 3.0 人体测量诊断与芝加哥 4.0 是否一致？

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2023-12-20 DOI: 10.1093/dote/doad071

Angélica Tobón, Albis C Hani, Cristiam D Pulgarin, Andres F Ardila, Oscar M Muñoz, Julian A Sierra, Daniel Cisternas

Summary There is little information on the degree of concordance between the results obtained using the Chicago 3.0 (CCv3.0) and Chicago 4.0 (CCv4.0) protocols to interpret high-resolution manometry (HRM) seeking to determine the value provided by the new swallowing maneuvers included in the last protocol. This is a study of diagnostic tests, evaluating concordance by consistency between the results obtained by the CCv3.0 and CCv4.0 protocols, in patients undergoing HRM. Concordance was assessed with the kappa test. Bland–Altman scatter plots, and Lin’s correlation-concordance coefficient (CCC) were used to assess the agreement between IRP measured with swallows in the supine and seated position or with solid swallows. One hundred thirty-two patients were included (65% women, age 53 ± 17 years). The most frequent HRM indication was dysphagia (46.1%). Type I was the most common type of gastroesophageal junction. The most frequent CCv4.0 diagnoses were normal esophageal motility (68.9%), achalasia (15.5%), and ineffective esophageal motility (IEM; 5.3%). The agreement between the results was substantial (Kappa 0.77 ± 0.05), with a total agreement of 87.9%. Diagnostic reclassification occurred in 12.1%, from IEM in CCv3.0 to normal esophageal motility in CCv4.0. Similarly, there was a high level of agreement between the IRP measured in the supine compared to the seated position (CCC0.92) and with solid swallows (CCC0.96). In conclusion, the CCv4.0 protocol presents a high concordance compared to CCv3.0. In the majority of manometric diagnoses there is no reclassification of patients with provocation tests. However, the more restrictive criteria of CCv4.0 achieve a better reclassification of patients with IEM.

摘要有关使用芝加哥 3.0（CCv3.0）和芝加哥 4.0（CCv4.0）方案解释高分辨率测压（HRM）所获结果的一致性程度的信息很少，目的是确定最后一个方案中包含的新吞咽动作所提供的价值。这是一项诊断测试研究，通过CCv3.0和CCv4.0协议在接受高分辨率测压的患者中获得的结果之间的一致性来评估一致性。一致性通过卡帕检验进行评估。使用Bland-Altman散点图和Lin相关-一致性系数（CCC）来评估仰卧位和坐位吞咽或固体吞咽时测量的IRP之间的一致性。共纳入 132 名患者（65% 为女性，年龄为 53±17 岁）。最常见的 HRM 适应症是吞咽困难（46.1%）。I 型是最常见的胃食管交界处类型。最常见的 CCv4.0 诊断是食管运动正常（68.9%）、贲门失弛缓症（15.5%）和食管运动无效（IEM；5.3%）。结果之间的一致性很高（Kappa 0.77 ± 0.05），总一致性为 87.9%。12.1%的患者出现了诊断重新分类，从CCv3.0的IEM到CCv4.0的正常食管运动。同样，仰卧位与坐位测量的 IRP（CCC0.92）和固体吞咽（CCC0.96）之间的一致性也很高。总之，与 CCv3.0 相比，CCv4.0 协议具有很高的一致性。在大多数测压诊断中，对接受激发试验的患者没有重新分类。然而，CCv4.0 更严格的标准能更好地对 IEM 患者进行重新分类。

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引用次数: 0

Management and outcomes in a consecutive series of patients with aero-digestive fistula at a tertiary gastro-esophageal surgery center 一家三级胃食管外科中心连续收治的一系列消化道瘘患者的管理和治疗效果

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2023-12-15 DOI: 10.1093/dote/doad068

Fahad Murad, Fredrik Klevebro, Gert Henriksson, Ioannis Rouvelas, Mats Lindblad, Magnus Nilsson

Summary Aerodigestive fistula (ADF) is defined as a pathological connection between the upper digestive tract and the airway. ADF is associated with high morbidity and mortality and management is often complex. A cohort study including all patients admitted with ADF 2004–2022 at a single tertiary esophageal surgery center was performed based on prospectively collected administrative data and retrospectively collected electronic patient chart data,. Patient demographics, performance status, comorbidity, fistula characteristics, management, and outcomes in terms of morbidity and mortality were assessed in patients with ADF of three distinct types: (i) tumor overgrowth-related, (ii) various benign etiologies, and (iii) post-esophagectomy. Sixty-one patients with ADF were included in the study, 33 (54.1%) tumor overgrowth-related, six (9.8%) benign and 22 (36.1%) post-esophagectomy. In the post-esophagectomy group 15 out of 22 (68.2%) patients were diagnosed with anastomotic leakage prior to ADF diagnosis. Self-expandable metallic stents (SEMS) were used for temporary fistula sealing in 59 out of 61 (96.7%) patients, of which most received stents in both the digestive tract and airway. Temporary fistula sealing with stents was successful enabling discharge from hospital in 47 out of 59 (79.7%) patients. Definitive ADF repair was performed in 16 (26.2%) patients, of which one (6.3%) died within 90-days and 15 could be discharged home with permanently sealed fistulas. ADF is a complex condition associated with high mortality, which often requires multiple advanced interventions. SEMS can be applied in the airway and simultaneously in the digestive tract to temporarily seal the ADF as bridge to definitive surgical repair.

摘要消化道瘘（ADF）是指上消化道与气道之间的病理连接。ADF 与高发病率和高死亡率有关，其治疗通常比较复杂。根据前瞻性收集的管理数据和回顾性收集的电子病历数据，对一家三级食管外科中心 2004-2022 年收治的所有 ADF 患者进行了一项队列研究。研究评估了三种不同类型的 ADF 患者的人口统计学特征、表现状态、合并症、瘘管特征、管理以及发病率和死亡率方面的结果：(i) 肿瘤过度生长相关，(ii) 各种良性病因，(iii) 食管切除术后。研究共纳入 61 例 ADF 患者，其中 33 例（54.1%）与肿瘤过度生长有关，6 例（9.8%）为良性病因，22 例（36.1%）为食道切除术后病因。在食管切除术后组中，22 位患者中有 15 位（68.2%）在确诊 ADF 之前已被诊断为吻合口漏。61名患者中有59名（96.7%）使用了自膨胀金属支架（SEMS）进行临时瘘管封堵，其中大多数患者在消化道和气道都使用了支架。在 59 名患者中，有 47 名（79.7%）成功使用支架临时封堵了瘘管，并顺利出院。16名患者（26.2%）接受了ADF最终修复手术，其中1名患者（6.3%）在90天内死亡，15名患者的瘘管被永久封堵，可以出院回家。ADF 是一种复杂的疾病，死亡率很高，通常需要多种先进的干预措施。SEMS 可用于气道，同时也可用于消化道，以暂时封闭 ADF，作为最终手术修复的桥梁。

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引用次数: 0

Effectiveness and safety of stag beetle knife (SB knife) in management of Zenker’s diverticulum: a systematic review and meta-analysis 矢车菊刀（SB刀）治疗禅克氏憩室的有效性和安全性：系统综述和荟萃分析

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2023-12-15 DOI: 10.1093/dote/doad069

Dushyant Singh Dahiya, Smit Deliwala, Saurabh Chandan, Daryl Ramai, Hassam Ali, Lena L Kassab, Antonio Facciorusso, Gursimran S Kochhar

Summary Stag Beetle Knife (SB Knife) is increasingly being utilized for Zenker’s Diverticulectomy (ZD). Our study assessed the effectiveness and safety of the SB Knife for the management of ZD. Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov, Scopus, and Web of Science were searched to identify studies that utilized SB knife for ZD. Pooled proportions (PP) were calculated using the random-effects model. Heterogeneity was evaluated using I2 statistics. A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm and 28 (of 148) patients had undergone previous treatments. The PP of technical success was 98% (95% CI: 92.3–99.5; I20) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response at first follow-up and relapse after index procedure was 87.9% (95% CI: 81.6–92.3; I219) and 13.5% (95% CI: 9.6–18.6; I22), respectively. At final follow-up, the PP of clinical remission was 96.2% (95% CI: 91–98.4; I230.6) while the PP of procedure failure was 3.6% (95% CI: 1.6–8.1; I20). No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs was 13.2% (95% CI: 9.6–17.8; I20) and 9.3% (95% CI: 5.7–14.9; I2 < 20.9), respectively. SB Knife is highly safe and effective for Zenker’s Diverticulectomy with a failure rate of only 3.6%.

摘要雄甲虫刀（SB 刀）越来越多地被用于 Zenker 胃憩室切除术（ZD）。我们的研究评估了 SB 刀治疗 ZD 的有效性和安全性。我们检索了 Ovid EBM reviews、Ovid Embase、Ovid Medline、ClinicalTrials.gov、Scopus 和 Web of Science，以确定使用 SB 刀治疗 ZD 的研究。采用随机效应模型计算汇总比例（PP）。使用I2统计量评估异质性。最终分析共纳入了 7 项研究，268 名患者。吞咽困难和反胃是最常见的临床症状。ZD的平均大小为2.8 ± 0.7厘米，有28名患者（共148名）曾接受过治疗。技术成功率为98%（95% CI：92.3-99.5；I20），平均手术时间为26.2±8.3分钟。首次随访时的临床反应PP为87.9%（95% CI：81.6-92.3；I219），指数手术后复发的PP为13.5%（95% CI：9.6-18.6；I22）。在最终随访中，临床缓解率为96.2%（95% CI：91-98.4；I230.6），而手术失败率为3.6%（95% CI：1.6-8.1；I20）。使用 SB 刀时未发现严重不良事件（AE）。然而，术中和术后AEs的PP分别为13.2% (95% CI: 9.6-17.8; I20) 和9.3% (95% CI: 5.7-14.9; I2 < 20.9)。SB刀对Zenker氏憩室切除术非常安全有效，失败率仅为3.6%。

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引用次数: 0

41. HIGH COMPREHENSIVE COMPLICATION INDEX AFTER MINIMALLY INVASIVE ESOPHAGECTOMY ASSOCIATED WITH POOR SHORT-TERM AND LONG-TERM OUTCOME: A PROPENSITY SCORE MATCHING ANALYSIS 41. 微创食管切除术后综合并发症指数高与短期和长期预后差相关:倾向评分匹配分析

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.016

Ding-Qiang Chen, Junlan Cai, K. Weng, Zhinuan Hong

The comprehensive complication index (CCI) is a new index to comprehensively and systematically evaluate complication severity. The objective of this study was to evaluate the predictive ability of CCI on short—and long-term overall survival(OS) in patients with esophageal squamous cell carcinoma (ESCC) undergoing minimally invasive esophagectomy (MIE) based on a propensity Score Matching (PSM) analysis. A total of 356 patients treated with radical MIE from 2013 to 2017 were included, and the primary outcome was OS, and the secondary outcomes were postoperative hospital stay and hospital costs. Firstly, the optimla cut-off value of CCI was determined by X-tile. PSM was used to balance the baseline characteristics. Second, we compared postoperative hospital stay and hospital costs between high- and low-CCI group. Third, the Kaplan–Meier survival curve was used to analyze survival difference. Fourth, univariate and multivariate Cox analysis was used to explore the independent risk factors of OS. The CCI > 24.2 was defined as high-CCI group and CCI≦24.2 was defined as low-CCI group. The high-CCI group had more hospital costs and longer hospital stay than the low-CCI group both before and after PSM (p < 0.001). The K-M analysis indicated that patients with high CCI had worse prognosis both before and after PSM (before matching: P < 0.001; after matching: P = 0.04). CCI was determined as independent prognostic factor both before and after PSM (before PSM, P = 0.002; after PSM, P = 0.025). The CCI could quantify postoperative complications after esophagectomy. High CCI is associated with longer hospital stay and hospitalization costs, and is an independent risk factor for poor OS.

综合并发症指数(CCI)是一种综合系统评价并发症严重程度的新指标。本研究的目的是基于倾向评分匹配(PSM)分析，评估CCI对食管鳞状细胞癌(ESCC)微创食管切除术(MIE)患者短期和长期总生存(OS)的预测能力。纳入2013 - 2017年接受根治性MIE治疗的356例患者，主要终点为OS，次要终点为术后住院时间和住院费用。首先，通过X-tile确定CCI的最佳临界值。PSM用于平衡基线特征。其次，我们比较了高cci组和低cci组的术后住院时间和住院费用。第三，采用Kaplan-Meier生存曲线分析生存差异。第四，采用单因素和多因素Cox分析探讨OS的独立危险因素。以CCI≦24.2为高CCI组，以CCI≦24.2为低CCI组。高cci组在PSM前后的住院费用和住院时间均高于低cci组(p < 0.001)。K-M分析显示，高CCI患者在PSM前后预后均较差(配对前:P < 0.001;配对后:P = 0.04)。在PSM前后，CCI均被确定为独立预后因素(PSM前，P = 0.002;PSM后，P = 0.025)。CCI可以量化食管切除术后的并发症。高CCI与较长的住院时间和住院费用相关，是不良OS的独立危险因素。

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引用次数: 0

286. A BIBLIOMETRIC ANALYSIS OF NEOADJUVANT THERAPY FOR ESOPHAGEAL CANCER 286.食管癌新辅助治疗的文献计量学分析

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.117

Yizhou Huang, B. Zheng, Maohui Chen, Shuliang Zhang, T. Zeng, Chun Chen

The study aims to summarize publication characteristics of neoadjuvant therapy for esophageal cancer and create scientific maps to explore hotspots and emerging trends with bibliometric methods. The publications between 2013 and 2022 were retrieved from the Web of Science Core Collection (WoSCC) on March 4, 2023. Bibliometric tools including VOSviewer and CiteSpace were used for statistical analysis. Data on the trend of the annual output, countries/regions, institutions, journals, authors, subject categories, keywords, and co-cited references were presented in this study. A total of 1713 publications written by 9222 authors of 1696 institutions, 49 countries/regions in 287 journals were included in the bibliometric study. China was the most prolific country with 414 publications, and The United States was the country that cooperated most with other countries. Doki, yuichiro, van Hagen, p, annals of surgical oncology, j clin oncol, and sun yat sen univ were the top 1 productive author, co-cited author, productive journal, co-cited journal, and prolific institution, respectively. The top 4 most present keywords were esophageal cancer, neoadjuvant chemoradiotherapy, neoadjuvant chemotherapy, and chemotherapy. Furthermore, the clinical research hotspots involved in the immunotherapy of ESCC have received the most attention in recent years. This study visually analyzed the development status and scientific trend of neoadjuvant therapy for esophageal cancer over the past decade. The results could guide scientists to comprehensively understand the existing research and determine future directions. Web of Science (WOS); esophageal cancer; bibliometric analysis.

本研究旨在总结癌症新辅助治疗的出版特点，并创建科学地图，以文献计量方法探索热点和新趋势。2013年至2022年的出版物于2023年3月4日从网络科学核心收藏（WoSCC）中检索。包括VOSviewer和CiteSpace在内的文献计量工具用于统计分析。本研究提供了关于年度产出趋势、国家/地区、机构、期刊、作者、主题类别、关键词和共同引用参考文献的数据。文献计量学研究共收录了1713篇出版物，这些出版物由49个国家/地区的1696个机构的9222名作者在287种期刊上撰写。中国是最多产的国家，有414种出版物，美国是与其他国家合作最多的国家。Doki，yuichiro，van Hagen，p，《外科肿瘤学年鉴》，j clin oncol和sun yat-sen univ分别是第一大多产作者、共同引用作者、多产期刊、共同引用期刊和多产机构。最常见的四个关键词是食管癌症、新辅助放化疗、新辅助化疗和化疗。此外，近年来ESCC免疫治疗的临床研究热点也受到了极大的关注。本研究直观地分析了近十年来癌症新辅助治疗的发展现状和科学趋势。研究结果可以指导科学家全面了解现有研究并确定未来的方向。科学网；食管癌症；文献计量分析。

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引用次数: 0

473. PARACONDUIT HIATUS HERNIA AFTER OESOPHAGECTOMY: INCIDENCE, RISK FACTORS AND MANAGEMENT 食管切除术后导管旁裂孔疝的发生率、危险因素和处理

IF 2.6 3区医学 Q1 Medicine

Diseases of the Esophagus

Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.255

Rakesh Ahmed, J. Elliott, C. Donohoe, N. Ravi, J. Reynolds

Hiatus hernia after oesophagectomy is an uncommon but serious complication of oesophageal cancer surgery. With improving long-term oncologic outcomes, post oesophagectomy hiatus hernia is an increasingly recognised entity in oesophageal cancer survivorship. The aim of this study was to assess the incidence of and risk factors for paraconduit hiatus hernia (PHH), and to describe management approaches in a tertiary referral centre. All patients undergoing oesophagectomy for cancer from 2008 to 2022 were included. Early PHH was defined as occurring within 3 months of index surgery, with all other PHH defined as late PHH. Surveillance computed tomography scans were undertaken among all disease-free patients to 5-years postoperatively. Kaplan Meier and Cox proportional hazards regression models were used to determine independent risk factors for PHH. 897 patients were studied. Early PHH occurred in 1.2%, and late PHH in 5.7% of patients. There was no late recurrence after early PHH. PHH was an asymptomatic radiologic finding in 45.5% of early and 84.3% of late cases. Median time to PHH was 15.7 months postoperatively. Nausea, abdominal pain and vomiting were the most common symptoms associated with PHH. Surgical intervention was required in 25.8% of cases, more commonly following early PHH (63.6%) as compared with late PHH (17.6%, P < 0.01). Operative approach (P < 0.001), extended resection of crura or diaphragm (P < 0.001) and male sex (P = 0.037) were associated with increased risk of hiatus hernia. Paraconduit hiatus hernia is an uncommon complication after oncologic oesophagectomy. Surgical intervention is often required for patients with PHH presenting in the first three months after surgery, but a majority of patients with asymptomatic late PHH may be managed expectantly.

食管癌切除术后裂孔疝是食管癌手术中一种少见但严重的并发症。随着长期肿瘤预后的改善，食管切除术后裂孔疝在食管癌生存中越来越被认可。本研究的目的是评估管道旁裂孔疝(PHH)的发生率和危险因素，并描述三级转诊中心的管理方法。所有2008年至2022年因癌症接受食管癌切除术的患者均被纳入研究。早期PHH定义为发生在指数手术3个月内，所有其他PHH定义为晚期PHH。术后5年对所有无病患者进行计算机断层扫描监测。Kaplan Meier和Cox比例风险回归模型用于确定PHH的独立危险因素。研究了897例患者。早期PHH发生率为1.2%，晚期PHH发生率为5.7%。早期PHH无晚期复发。45.5%的早期和84.3%的晚期PHH是无症状的放射学发现。术后至PHH的中位时间为15.7个月。恶心、腹痛和呕吐是PHH最常见的症状。25.8%的病例需要手术治疗，早期PHH(63.6%)较晚期PHH (17.6%， P < 0.01)更为常见。手术入路(P < 0.001)、扩大脚或膈切除术(P < 0.001)和男性(P = 0.037)与裂孔疝的风险增加相关。摘要导管旁裂孔疝是肿瘤食管切除术后少见的并发症。对于术后前三个月出现PHH的患者，通常需要手术干预，但大多数无症状晚期PHH患者可能会得到预期的治疗。

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引用次数: 0