| Background and objective:esophageal cancer is one of the most common cancers of digestive system in the world.in the past few decades,its mortality has been increasing rapidly.although the control and prevention measures of esophageal cancer have been improved,the curative effect is not good.and the survival rate is generally very low within five years(10%,40%).Radical resection of esophageal cancer is the main treatment for patients with esophageal cancer at present.the perioperative factors that affect the prognosis of patients are very complex,including basic condition of patients,surgical operation,anesthetic management and so on.they have a far-reaching impact on cancer metastasis and recurrence,so in order to better clinical outcome,retrospective analysis of the relevant data of patients undergoing radical resection of esophageal cancer to judge the relationship between these factors and prognosis.Methods:the perioperative clinical and pathological data of 363 patients who underwent radical esophagectomy in the operating room of the High-tech Center of the first affiliated Hospital of Anhui Medical University from October 2017 to December 2019 were retrospectively analyzed.The patients were followed up every 3 months to June 2022 or died.Single-factor and multi-factor analysis can be carried out by using COX proportional risk model,and if P value is less than 0.1,it can be directly analyzed by multi-factor COX proportional regression model.The survival curve was made according to KaPlan-Meier method,and the comparison between survival curves was examined by Log-rank.All patients were examined bilaterally,and the difference of P<0.05 was statistically significant.</br>Results:217 elderly(≥65 years old),146middle-aged(<65 years old),281 males,82 females,74 with history of hypertension,289 without history of hypertension,62 with history of diabetes,301 with no history of diabetes,151 with history of smoking,212with history of smoking,108with history of drinking,255with no history of drinking,20with history of chronic gastritis,343with no history of chronic gastritis,301 with ASA grade Ⅲ,62cases with ASA grade Ⅳ.There were 21 cases of cardiac function grade 1,316 cases of cardiac function grade 2,26 cases of cardiac function grade 3,36 cases of intravenous inhalation combined with general anesthesia,327 cases of epidural anesthesia,263 cases of endoscopic surgery,155cases of intrathoracic anastomosis,208cases of TNM stage Ⅰ-Ⅱ grade,131cases of TNM stage Ⅲ-Ⅳgrade,41 cases of upper esophageal carcinoma,222cases of middle esophageal carcinoma,100cases of lower esophageal cancer and 256cases of tumor diameter ≥3cm.The maximum diameter of tumor was less than 3 cm in 107 cases,tumor invasion beyond muscle layer in 214 cases,tumor invasion not exceeding muscle layer in 149 cases,high differentiation of tumor cells in 62 cases,moderate differentiation in 159 cases,low differentiation in 142 cases,tumor nerve invasion in 137 cases,tumor nerve invasion in 226 cases,tumor thrombus in 135 cases,no tumor thrombus in 228 cases,lymph node metastasis in 152 cases,no lymph node metastasis in 211 cases,postoperative use of analgesics for more than 5 days in 219 cases.Postoperative analgesics were less than 5 days in 144cases,preoperative renal function was normal in 293cases,preoperative renal insufficiency in 70 cases,postoperative radiotherapy and chemotherapy in 142cases,postoperative pneumonia in 174cases,no pneumonia in 189cases,postoperative pleural effusion in 148cases,no pleural effusion in 215cases,univariate analysis of COX proportional hazard model showed that there were no postoperative pleural effusion.The age,body mass index,smoking history,drinking history,tumor location,operation mode,anastomotic position,operation time,postoperative pneumonia and pleural effusion were not significantly correlated with total survival time(overallsurvival,OS).TNM stage,maximum diameter of tumor,degree of differentiation and depth of invasion,lymph node metastasis,tumor nerve invasion and tumor thrombus,postoperative radiotherapy and chemotherapy,duration of postoperative analgesics were significantly correlated with OS.Multivariate regression analysis showed that TNM staging(P<0.001),tumor differentiation(P<0.008)and duration of postoperative analgesic use(P<0.010)were significantly correlated with OS.The median survival time of postoperative analgesics less than 5 days(51.0 months)was significantly longer than that of postoperative analgesics more than 5 days(36.0 months).Conclusion:1 the postoperative prognosis of patients with esophageal cancer is affected by multiple factors.TNM stage,the level of cell differentiation and the time of use of postoperative analgesics are independent risk factors for OS.2 the age of patients with esophageal cancer should not be the reason to limit their operation.For patients who can tolerate surgery,radical excision of the lesion should be performed.3 operative mode,operation time,postoperative pneumonia and postoperative pleural effusion are not independent risk factors for the prognosis of esophageal cancer. |
PDF Full Text Request