Comparison Of Survival Rate,Complications And Life Quality After Different Surgical Procedures In Esophageal Cancer

Objective: The aim is to compare the survival rate,post-operative complications and long-term life quality in esophageal cancer patients underwent different surgical procedures,by analyzing the data of 401 patients with esophageal carcinoma,in our hospital.Methods: We successfully followed up 401 cases from 433 cases(92.6%)of esophageal cancer patients underwent surgery treatment in our department.According to the surgical procedures,patients were divided into six groups: Sweet group(n=269),Ivor-lewis group(n=47),Mckeown group(n=26),minimally invasive esophagectomy(MIE)group(n=41),colonic interposition for esophageal substitution(CIES)group(n=9),and subtotal resection of esophageal through left thoracic and esophagogastroanastomosis in left neck(SRELTELN)group(n=9).Log-Rank test was performed to determine the difference between Kaplan-Meier survival curves.Multivariate survival analysis using Cox's proportional hazards regression model was performed to evaluate the death risks among different groups.The post-operative conditions and life quality during follow-up were also compared.Results: 1 The 1,2,3,4 and 5-year survival rates for this cohort of esophageal cancer patients were 86%,73%,65%,57%,53%,and the median survival time is 2244 day;2 Log-Rank test results: The pTNM sage,histological type and the surgical approach are the prognostic factors of the Postoperative patients with esophageal carcinoma(P<0.05).And,The survival distribution was statistical among different surgical procedure groups(P <0.05).The 3 and 5-year survival rates were highest in the MIE group and lowest in the SRELTELN group.The 3 and 5-year survival rates in Sweet group and Ivor-lewis group were also lower than MIE group(P<0.05).However,the survival distributions in the Mckeown group were not statistically different from MIE group(P>0.05);3 In a multivariate Cox proportional-hazards regression model: adjusting for other confounding factors,in aspect of pTNM stage,stageIII and the above had a higher risk of death than stage I(HR=4.208,95%CI:[1.107,15.992],P =0.035);the involved nodes > or =3(including N2 and N3),compared to N0,had more risk of death(HR=2.447,95%CI :[1.167,5.192],P =0.018),but the N1 did not;in the location of carcinoma: the upper(HR=3.187,95%CI[1.515,6.706],P =0.002)and also the middle(HR=1.750,95%CI [1.102,2.780],P =0.018)of the esophageal had a higher risk of death than distal of the esophagus;in the type of histopathological: patients with the esophageal adenocarcinoma did not increase the risk of death,although it has an increasing incidence rate in modern life(P>0.05);in the approaches of operation: Compared to MIE group,the adjust death risk hazard ratio(HR)for the SRELTELN group was higher(HR=7.937,95%CI:[ 2.451,25.696 ],P =0.001),whereas HRs in all the other groups were not different statistically(P>0.05);4 Compared with different approaches of operation for patients with esophageal carcinoma: The length of hospital stay,Operative blood loss,The number of lymph node dissection,the day of Postoperative ICU,Postoperative anemia,hypoproteinemia,pulmonary atelectasis,pleural thickening adhesion,anastomotic leakage;and the drainage volume of chest,neck and abdomen were different in ways of operation(P<0.05).We also find the results: The MIE group had the lowest intra-operative blood loss and post-operative drainage,and the hospital stay length of the MIE was shorter than the SRELTELN group.The accident of post-operative anemia and hypoproteinemia in the group of MIE and Sweet is lowest.Moreover,the incidence of MIE of Postoperative pneumonia,cardiac complications(mainly about arrhythmia),and chylothorax was not statistically different with other groups(P>0.05).However,there was a higher incidence of anastomotic leakage of the MIE and Mckeown than the Sweet.Then,compared to Mckeown,the incidence of anastomotic leakage and pulmonary atelectasis of Sweet group is lower.The incidence of postoperative pulmonary atelectasis,pleural thickening adhesion and the highest amount of post-operative drainage of Mckeown group was highest;5 Follow-up results: Most of the postoperative patients of esophageal carcinoma had a better appetite,more diet intake,and ate solid food in our Department.They had a good physiological status.Especially,the condition of postoperation(the score of ECOG and KPS),at 6th.mouths had an ideal result.But,we also find that the group of MIE was more prone to dysphagia than the group of Sweet and Ivor-Lewis;in the other group(including Mckeown,CIES and SRELTELN),there was a higher incidence rate of poor appetite,anorexia and the sense of full belly after eating;and the patients of group of Ivor-Lewis were more likely happen to pain when eating.Conclusions:1 The MIE group did not increase the risk of death compared to other groups.Whereas,the patients of MIE had less intro-or post-operative complications and less postoperative drainage volume,quicker recovery than others.The technique of MIE has a good development trend.2 There still are certain advantages in the way of Sweet.Because it has less postoperative complications and quicker recovery.3 There were the worst survival rate and the most intro-and post-operative complications in the group of SRELTELN.