Symptoms With Gastrointestinal Function Following Esophagectomy For Patients With Esophageal Cancer

Objective:1 To learn the incidence of symptoms with gastrointestinal functionfollowing esophagogastrostomy for patients with esophageal cancer.2 To determine the affecting factors of dysphagia followingesophagectomy.3 To understand the influencing factors of symptoms withgastroesophageal reflux following esophagectomy.Methods:1 A total of 1019 patients with esophageal cancer receivedesophagogastrostomy were investigated from September 2011 to March2012 in the Affiliated Hospital of North Sichuan Medical College withself-made Gastrointestinal Function Questionnaire.2 Uuivariate analyses and multivariate analysis were performed todetermine the affecting factors for dysphagia and symptoms forgastroesophageal reflux.Results:1 The total incidence of gastrointestinal symptoms following esophagectomy is 83.51%, which include decreased appetite(58.58%)、dietcut down(78.21%)、abspecken(76.84%)、dysphagia(6.10%)、anastomoticstricture(3.05%)、gastroesophageal reflux(59.08%)、chest stomachsyndrome(30.23%)、dumping syndrome(32.78%)、diarrhea(20.71%)、constipation (1.08%).2 The anesis way of anastomotic stricture: esophageal dilatation(70.97%)、esophageal stent (29.03%); the incidence of gastroesophagealreflux、chest stomach syndrome and dumping syndrome need drug treatmentare 82.72%、19.48%、8.38% respectively.3 The incidence of symptoms with gastrointestinal function in 3months、3-6months、6-9months、9-12months、12-24months、≥24monthsafter operation are 88.54%、85.83%、81.50%、85.98%、80.22%、77.55%respectively; dysphagia are 4.45%、4.33%、4.32%、4.67%、9.35%、10.20%respectively; anastomotic stricture are 3.82%、2.76%、2.31%、2.94%、3.24%、4.08% respectively; gastroesophageal reflux are 66.24%、59.84%、60.69%、55.14%、56.47%、51.02% respectively; chest stomach syndrome are 43.31%、37.80%、17.34%、29.11%、25.18%、26.53% respectively; dumping syndromeare 33.76%、31.10%、29.48%、36.45%、35.97%、22.45% respectively;diarrhea are 18.47%、18.11%、20.81%、28.97%、21.58%、18.37%respectively. 3 The results of oneway analysis of variance3.1 DysphagiaThese patients who had anastomotic leak are much higher than thesewho did not have anastomotic leak at the incidence of dysphagia (P<0.001);males and patients whose postoperative time are above at 24 months havehigher incidence of dysphagia than females and the others time slot(P<0.005). The rest of the possible affect factors have nothing to do withdysphagia (P>0.005).3.2 Gastroesophageal RefluxTumor location、replacement organs(anastomosis methods)、anastomosis place、postoperative time(linear-by-linear association test) areassociation with gastroesophageal reflux (P<0.005). The rest of the possiblefactors have nothing to do with gastroesophageal reflux (P>0.005).4 The results of multiple logistic regressions4.1 DysphagiaThe incidences of dysphagia are association with gender andpostoperative time (≥24 months). Males and patients whose postoperativetimes are above at 24 months have much higher incidence of dysphagia thanfemales and the others time slot. 4.2 Gastroesophageal RefluxThe incidence of gastroesophageal reflux following esophagectomy:upper esophageal cancer>middle-third esophageal cancer>lower esophagealcancer; anastomosis in neck>anastomosis in subaortic arch>anastomosis insupra-aortic arch; use the whole stomach to instead esophagus (mechanicalanastomosis)>use a narrow stomach to replace esophagus (handseamanastomosis).Conclusions:1 The total incidence of gastrointestinal symptoms followingesophagectomy is 83.51%, and it will reduced gradually as times; theincidence of dysphagia will increased gradually. half of the dysphagias areanastomotic stricture, and 70.97% of these can be cured by esophagealdilatation; according to the gastrointestinal symptoms, the incidence is highand the symptom is critical, most of these patients need drug treatment; andcontrary to the chest stomach syndrome and dumping syndrome, theincidence is low and the symptoms are slight, little patients need drugtreatment; the incidence of diarrhea is 20.71%.2 The incidence of dysphagia is 6.10%, half of dysphagia (3.05%) needesophageal dilatation. anastomotic leak、gender and postoperative time (≥24months) are the affect factors of dysphagia. These patients who hadanastomotic leak had much more chance to get dysphagia than these who did not have anastomotic leak; males have higher incidence of dysphagia thanfemales, but both the males and the females are the same incidence inesophageal dilatation; the patients whose postoperative time are above at 24months have a higher incidence of dysphagia than the others time slot, thatmay be association with the tumor recurrence.3 The incidence of gastroesophageal reflux following esophagectomy is54.56%, and which reduced gradually as times, but the symptom is alwayscritical, most of these patients need drug treatment; use a narrow stomach toinstead esophagus(handmade anastomosis)、go through esophageal bed andanastomosis in supra-aortic arch can effectively reduce the incidence ofgastroesophageal reflux symptoms.