Fast track surgery for elderly patients with esophageal cancer

doi:10.3877/cma.j.issn.2095-8773.2016.02.005

Abstract

Abstract:

Objective

To investigate the feasibility, safety and short-term outcome of fast track surgery for elderly patients with esophageal cancer.

Methods

The clinical data of 102 elderly patients with esophagealcancer undergoing minimally invasive surgery in Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University between January 2013 and March 2016 were retrospectively analyzed. Among the 102 patients, 68 were males and 34 were females, with the mean age of (74.1 ± 3.6) years(range, 70-92 years). Fifty-five patients were in fast track surgery group, and the other 47 patients were in control group. Patients in both groups received minimally-invasive thoracolaparoscopic oesophagectomy with two-field lymphadenectomy under general anesthesia. The observed indicators included preoperative comorbidity, blood loss during operation, operation time, postoperative complications, length of postoperative stay and hospitalization expense.

Results

There was no significant difference in baseline data before operation between two groups(P>0.05). Nasogastric tubes were placed and early oral feeding was discontinueddue to postoperative complications in fast track surgery group. Allpatients in control group tolerated enteral nutrition well.No perioperative death occurred in two groups. There was no significant difference between fast track surgery groupand control group in the incidences of postoperative complications(34.5% vs 38.2%, χ²=0.154, P=0.694) and second ICU treatment (3.6% vs 6.3%, χ²=0.410, P=0.522). The length of postoperative stay was lower and the hospitalization expense was lower in fast track surgery group than in control group[(7.8±1.6) d vs (12.8±2.3) d, Z=-12.756, P<0.001; (26 332±12 355) RMB vs (39 810±15 846) RMB, Z=-9.452, P<0.001].

Conclusion

Fast track surgery is feasible and safefor elderly patients with esophageal cancer, which can reduce the length of postoperative stay and hospitalization expense, and hasten the recovery.

Key words: Esophageal cancer, Elderly patient, Thoracolaparoscopic oesophagectomy, Fast track surgery

Qi Liu, Yin Li, Xianben Liu, Haibo Sun, Ruixiang Zhang, Zongfei Wang, Yan Zheng, Shilei Liu, Xionghuai Hua, Yongkui Yu, Haomiao Li, Xiankai Chen. Fast track surgery for elderly patients with esophageal cancer[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(02): 89-94.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxbwkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8773.2016.02.005

https://zhxbwkdzzz.cma-cmc.com.cn/EN/Y2016/V03/I02/89

Figures/Tables 2

References 20

[1]	JougonJB,BallesterM,DuffyJ, et al. Esophagectomy for cancer in the patient aged 70 years and older[J]. AnThorac Surg, 1997, 63(5): 1423-1427.
[2]	OhnoS,KubotaH,MasunagaR, et al. Esophageal resection in elderly esophageal carcinoma patients: improvement in postoperative complications[J]. Ann ThoracSurg, 2001, 71(2): 414-418.
[3]	SihagS,WrightCD,WainJC, et al. Comparison of perioperative outcomes following open versus minimally invasive Ivor Lewis oesophagectomy at a single, high-volume centre[J]. Eur J Cardiothorac Surg, 2012, 42(3): 430-437.
[4]	LichtmanSM,BalducciL,AaproM. Geriatric oncology: a field coming of age[J]. J Clin Oncol，2007, 25(14): 1821-1823.
[5]	TalaricoL,ChenG,PazdurR. Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration[J]. J Clin Oncol, 2004, 22(22): 4626-4631.
[6]	AsmisTR,DingK,SeymourL, et al. Age and comorbidity as independent prognostic factors in the treatment of non small-cell lung cancer: a review of National Cancer Institute of Canada Clinical Trials Group trials[J]. J Clin Oncol, 2008, 26(1): 54-59.
[7]	姚玉春，胥永忠. 食管癌患者围手术期死亡的高危因素分析[J]．中国胸心血管外科临床杂志，2002, 9(4): 311-312.
[8]	GriffinS,DesaiJ,CharltonM, et al. Factors influencing mortality and morbidity following oesophageal resection[J]. Eur J Cardiothorac Surg, 1989, 3(5): 419-423; discussion 424.
[9]	许庆生，支修益，张毅，等. 75岁以上高龄食管、贲门癌患者的外科治疗[J]. 中国胸心血管外科临床杂志，2009, 16(3): 237-239.
[10]	李印. 快速康复外科在食管癌治疗中的应用[J]. 中华胃肠外科杂志，2014, (9): 865-868.
[11]	CarterJ,SzaboR,SimWW, et al. Fast track surgery: a clinical audit[J]. Aust N Z J Obstet Gynaecol, 2010, 50(2): 159-163.
[12]	AlamN,FloresRM. Video-assisted thoracic surgery (VATS) lobectomy: the evidence base[J]. JSLS, 2007, 11(3): 368-374.
[13]	McKennaRJ Jr,MahtabifardA,PickensA, et al. Fast-tracking after video-assisted thoracoscopic surgery lobectomy, segmentectomy, and pneumonectomy[J]. Ann Thorac Surg, 2007, 84(5): 1663-1667; discussion 1667-1668.
[14]	ZhengY,LiY,WangZ, et al. A video demonstration of the Li's anastomosis-the key part of the "non-tube no fasting" fast track program for resectable esophageal carcinoma[J]. J Thorac Dis, 2015, 7(7): 1264-1268.
[15]	SunHB,LiY,LiuXB, et al. Embedded three-Layer esophagogastric anastomosis reduces morbidity and improves short-term outcomes after esophagectomy for cancer[J]. Ann Thorac Surg, 2016, 101(3): 1131-1138.
[16]	雷文章，赵高平，李卡，等. 胃肠减压在下消化道切除吻合术后应用的必要性评价[J]. 中华胃肠外科杂志，2005, 8(3): 203-205.
[17]	孙海波，李印，刘先本，等. 食管癌微创手术后不放胃管不禁食的可行性研究[J]．中华胃肠外科杂志，2014, (9): 898-901.
[18]	陈先凯，李印，刘先本，等. 加速康复外科在胸腹腔镜食管癌术中的临床应用[J]. 中华消化外科杂志，2015, 12(14): 987-992.
[19]	魏秀峰，李印，孙海波，等. 快速康复外科模式对食管癌术后患者近期生活质量的影响[J]. 中华胸心血管外科杂志，2014, 30(12): 705-710.
[20]	王总飞，李印，郑燕等食管癌腔镜术后营养途径的选择[J]. 中国肿瘤临床，2014, (23): 1490-1494.

指标		加速康复组(55例)	对照组(47例)	检验值	P值
年龄(±s，岁)		74.5±4.2	73.8±2.7	t＝1.10	0.315
性别(例)		?	?	χ²＝0.079	0.779
?	男性	36	32	?	?
?	女性	19	15	?	?
BMI(例)		?	?	χ²＝2.787	0.112
?	<25 kg/m²	44	38	?	?
?	≥25 kg/m²	11	08	?	?
肿瘤病理分期(例)		?	?	χ²＝2.232	0.223
?	Ⅰ期	17	15	?	?
?	Ⅱ期	28	22	?	?
?	Ⅲ期	10	10	?	?
手术时间(±s，min)		206.2±27.7	205.5±27.5	t＝0.315	0.893
术中出血量(±s，ml)		56.9±28.7	61.7±28.4	t＝－0.682	0.433
淋巴结清扫个数(枚)		29.6±11.9	26.4±9.8	t＝1.493	0.138
术前合并症(例)		32	30	t＝0.649	0.421

指标		加速康复组(55例)	对照组(47例)	检验值	P值
年龄(±s，岁)		74.5±4.2	73.8±2.7	t＝1.10	0.315
性别(例)		?	?	χ²＝0.079	0.779
?	男性	36	32	?	?
?	女性	19	15	?	?
BMI(例)		?	?	χ²＝2.787	0.112
?	<25 kg/m²	44	38	?	?
?	≥25 kg/m²	11	08	?	?
肿瘤病理分期(例)		?	?	χ²＝2.232	0.223
?	Ⅰ期	17	15	?	?
?	Ⅱ期	28	22	?	?
?	Ⅲ期	10	10	?	?
手术时间(±s，min)		206.2±27.7	205.5±27.5	t＝0.315	0.893
术中出血量(±s，ml)		56.9±28.7	61.7±28.4	t＝－0.682	0.433
淋巴结清扫个数(枚)		29.6±11.9	26.4±9.8	t＝1.493	0.138
术前合并症(例)		32	30	t＝0.649	0.421

相关指标	加速康复组(55例)	对照组(47例)	检验值	P值
心律失常[例(%)]	05(9.1)	05(10.6)	χ²＝0.069	0.793
肺炎[例(%)]	06(10.9)	05(10.6)	χ²＝0.002	0.965
肺不张[例(%)]	02(3.6)	01(2.1)	χ²＝0.202	0.653
纵隔感染[例(%)]	01(1.8)	0(0)0	χ²＝0.863	0.353
切口感染[例(%)]	02(3.6)	02(4.2)	χ²＝0.026	0.872
胸腔积液[例(%)]	01(1.8)	02(4.2)	χ²＝0.527	0.468
呼吸窘迫综合征[例(%)]	01(1.8)	01(2.1)	χ²＝0.013	0.911
吻合口瘘[例(%)]	01(1.8)	01(2.1)	χ²＝0.013	0.911
喉返神经损伤[例(%)]	06(10.9)	06(12.6)	χ²＝0.084	0.772
急性心功能不全[例(%)]	01(1.8)	02(4.2)	χ²＝0.527	0.468
总并发症[例(%)]	19(34.5)	18(38.2)	χ²＝0.154	0.694
围手术期死亡[例(%)]	0(0)0	0(0)0	－	－
术后再次入住ICU[例(%)]	02(3.6)	03(6.3)	χ²＝0.410	0.522
出院后3周再入院治疗[例(%)]	01(1.8)	01(2.1)	χ²＝0.013	0.911
术后住院天数( ±s，d)	7.8±1.6	12.8±2.3	Z＝－12.756	<0.001
术后住院费用( ±s，元)	26 332±12 355	39 810±15 846	Z＝－9.452	<0.001

相关指标	加速康复组(55例)	对照组(47例)	检验值	P值
心律失常[例(%)]	05(9.1)	05(10.6)	χ²＝0.069	0.793
肺炎[例(%)]	06(10.9)	05(10.6)	χ²＝0.002	0.965
肺不张[例(%)]	02(3.6)	01(2.1)	χ²＝0.202	0.653
纵隔感染[例(%)]	01(1.8)	0(0)0	χ²＝0.863	0.353
切口感染[例(%)]	02(3.6)	02(4.2)	χ²＝0.026	0.872
胸腔积液[例(%)]	01(1.8)	02(4.2)	χ²＝0.527	0.468
呼吸窘迫综合征[例(%)]	01(1.8)	01(2.1)	χ²＝0.013	0.911
吻合口瘘[例(%)]	01(1.8)	01(2.1)	χ²＝0.013	0.911
喉返神经损伤[例(%)]	06(10.9)	06(12.6)	χ²＝0.084	0.772
急性心功能不全[例(%)]	01(1.8)	02(4.2)	χ²＝0.527	0.468
总并发症[例(%)]	19(34.5)	18(38.2)	χ²＝0.154	0.694
围手术期死亡[例(%)]	0(0)0	0(0)0	－	－
术后再次入住ICU[例(%)]	02(3.6)	03(6.3)	χ²＝0.410	0.522
出院后3周再入院治疗[例(%)]	01(1.8)	01(2.1)	χ²＝0.013	0.911
术后住院天数( ±s，d)	7.8±1.6	12.8±2.3	Z＝－12.756	<0.001
术后住院费用( ±s，元)	26 332±12 355	39 810±15 846	Z＝－9.452	<0.001

Please choose a citation manager

Content to export