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Prevalence and risk factors of reflux after esophagectomy for esophageal cancer.

ABSTRACT: Background:Reflux symptoms including various extra-esophageal manifestations are commonly reported after esophagectomy. However, the intensity and presentation of reflux are both diverse and variable by patients. In this study we assessed reflux symptoms using the reflux symptom index (RSI) questionnaire in patients who underwent esophagectomy for esophageal cancer to order to identify the prevalence of significant reflux and its risk factors. Methods:From April 2017 to July 2017, we investigated patients who underwent esophagectomy for esophageal cancer. The severity of reflux was evaluated with a self-administered nine-item outcomes instrument (score: 0 to 5). An RSI score ?13 was considered significant reflux. Multivariable analysis was conducted to identify risk factors. Results:A total of 151 patients was included (mean age, 64.1±8.8 years; male, n=136, 90.1%). The median time after esophagectomy was 22.6 months. The question regarding heartburn, chest pain, indigestion, or acid coming up was most frequently responded (n=104, 68.9%) with 41 (27.2%) patients presenting significant reflux (mean RSI score, 19.9±6.3). Time after esophagectomy <2 years, vocal cord palsy, retrosternal route of reconstruction, and postoperative weight loss were identified as significant risk factors for RSI ?13 in the multi-variable analysis. Conclusions:Reflux related symptoms including extra-esophageal manifestations were common. Our study revealed that short duration after esophagectomy, vocal cord palsy, retrosternal route of reconstruction, and postoperative weight loss were significant associated factors for reflux symptom after esophagectomy.

SUBMITTER: Park S

PROVIDER: S-EPMC7139076 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Prevalence and risk factors of reflux after esophagectomy for esophageal cancer.

Park Samina S Kang Chang Hyun CH Lee Hyun Joo HJ Park In Kyu IK Kim Young Tae YT

Journal of thoracic disease 20200301 3

<h4>Background</h4>Reflux symptoms including various extra-esophageal manifestations are commonly reported after esophagectomy. However, the intensity and presentation of reflux are both diverse and variable by patients. In this study we assessed reflux symptoms using the reflux symptom index (RSI) questionnaire in patients who underwent esophagectomy for esophageal cancer to order to identify the prevalence of significant reflux and its risk factors.<h4>Methods</h4>From April 2017 to July 2017, ...[more]

PMID: 32274121

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Project description:BackgroundThe increase in the incidence of esophageal cancers (ECs) combined with fewer surgeons working at large centers will increase the likelihood of surgery for ECs being performed during later hours. This study aimed to compare esophagectomies' operative outcomes for EC performed at different surgical starting times.MethodsThis was a single-center, retrospective study. Risk-adjusted cumulative sum curve analysis and Cox regression analysis were used to identify the potential change-point of surgical starting times. The participants were then divided into 2 groups according to the change-point time. Propensity score matching was used to control confounding factors between the 2 groups. We compared the short- and long-term outcomes in both groups.ResultsA total of 702 patients who underwent potentially radical esophagectomy from 7 May 2014 to 31 December 2017 in our institute were included. The 3-year all-cause mortality showed a significant change-point at 16:42, with an increment from 56.5% to 76.9% (P=0.043). Esophagectomy that commenced between 17:00-18:59 was associated with significantly lower overall survival (OS) [multivariate hazard ratio (HR): 2.47; 95% confidence interval (CI): 1.25 to 4.90; P=0.010] and disease-free survival (DFS) (multivariate HR: 2.14; 95% CI: 1.08 to 4.21; P=0.028). The participants were allocated to the during-hours group and the after-hours group according to the change-point of 17:00. A total of 84 participants in the during-hours group were matched to 33 participants in the after-hours group. The median operative time was shorter in the after-hours group [309 (during-hours) vs. 239 (after-hours) minutes, P=0.014); the after-hours group had a greater incidence of respiratory complications (22.63% vs. 45.45%, P=0.023) and 90-day mortality (0 vs. 9.09%, P=0.021). The 5-year OS (P=0.042) and DFS (P=0.030) were significantly higher in the during-hours group.ConclusionsEsophagectomies started during after-hours are correlated with poorer surgical outcomes. It is recommended to cancel selective esophagectomies due to commence after 17:00.

Project description:To update our experiences with minimally invasive McKeown esophagectomy for esophageal cancer.We retrospectively reviewed the medical records of 445 consecutive patients who underwent minimally invasive McKeown esophagectomy between January 2009 and July 2015 at the Cancer Hospital of Chinese Academy of Medical Sciences and used 103 patients who underwent open McKeown esophagectomy in the same period as controls. Among 375 patients who underwent total minimally invasive McKeown esophagectomy, 180 in the early period were chosen for the study of learning curve of total minimally invasive McKeown esophagectomy. These 180 minimally invasive McKeown esophagectomies performed by five surgeons were divided into three groups according to time sequence as group 1 (n = 60), group 2 (n = 60) and group 3 (n = 60).Patients who underwent total minimally invasive McKeown esophagectomy had significantly less intraoperative blood loss than patients who underwent hybrid minimally invasive McKeown esophagectomy or open McKeown esophagectomy (100 mL vs 300 mL vs 200 mL, P = 0.001). However, there were no significant differences in operation time, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between total minimally invasive McKeown esophagectomy, hybrid minimally invasive McKeown esophagectomy and open McKeown esophagectomy groups. There were no significant differences in 5-year survival between these three groups (60.5% vs 47.9% vs 35.6%, P = 0.735). Patients in group 1 had significantly longer duration of operation than those in groups 2 and 3. There were no significant differences in intraoperative blood loss, number of harvested lymph nodes, or postoperative morbidity including incidence of pulmonary complication and anastomotic leak between groups 1, 2 and 3.Total minimally invasive McKeown esophagectomy was associated with reduced intraoperative blood loss and comparable short term and long term survival compared with hybrid minimally invasive McKeown esophagectomy or open Mckeown esophagectomy. At least 12 cases are needed to master total minimally invasive McKeown esophagectomy in a high volume center.

Dataset Information

Prevalence and risk factors of reflux after esophagectomy for esophageal cancer.

Publications

Prevalence and risk factors of reflux after esophagectomy for esophageal cancer.

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