| Objective:Objective Esophageal cancer is one of the common malignant tumors of the digestive tract that seriously affects human health.It is highly invasive,has high morbidity and mortality,and has poor treatment effects.Surgery is one of the main treatments for esophageal cancer,and postoperative complications are inevitable.Anastomotic leakage is a common and most dangerous postop-erative complication of esophageal cancer.The incidence rate in my country is about 5%-10%,and the mortality rate is as high as 50%.After the anastomotic fistula is healed,what measures can be taken to reduce recurrence and metastasis?The 2020 CSCO Guidelines for the Diagnosis and Treatment of Esophageal Cancer pointed out that for patients with postoperative pathological staging of esophageal squamous cell carcinoma of stage II and III,adjuvant chemotherapy may improve their overall survival rate,At the same time,it is pointed out that chemotherapy is generally carried out around 4 weeks to 1 month after surgery.However,patients with anastomotic fistula often need postoperative chemotherapy after the fistula is healed.Will the delay in treatment caused by the anastomotic fistula affect the prognosis? After treatment is delayed,there is no relevant research on whether further postoperative adjuvant chemotherapy is still needed.Therefore,this study mainly retrospectively classified the postoperative anastomotic fistula patients with esophageal squamous cell carcinoma of stage II-III.After the fistula healed,they were divided into a surgery group and a postoperative adjuvant chemotherapy group.Statistical analysis was performed to explore the esophagus.Whether the delay in treatment of patients with anastomotic fistula after squamous cell carcinoma surgery due to anastomotic leakage will affect the patient’s survival and disease-free survival,and whether further chemotherapy can improve the prognosis and increase the survival rate.Methods: From January 2010 to January 2019,we analyzed the medical records and return visit information of 189 patients with stage Ⅱ-Ⅲesophageal cancer postoperative anastomotic fistula treated in the Fourth Hospital of Hebei Medical University,and grouped these patients into postoperative groups.Divided into surgery alone group(S)107 cases,postoperative chemotherapy group(S+C)82 cases.By analyzing their age,gender,tumor location,tumor invasion depth(T stage),number of lymphatic metastases(N stage),postoperative pathological stage,the start time of chemotherapy after the anastomotic fistula is healed,and whether adjuvant chemotherapy is given after the operation,etc.Related factors,to explore the impact of postoperative treatment delay and adjuvant chemotherapy on the survival of patients with stage Ⅱ and Ⅲ esophageal cancer radical resection,in order to guide clinical practice.The relevant information of the follow-up patients includes: current survival status,time of death and cause of death,surgical methods,current dietary status,current functional status and quality of life(KPS score),recent weight changes,current positive symptoms,latest review time and location,Related items to be reviewed and the results of the review,time of recurrence or metastasis,location of recurrence or metastasis,whether adjuvant chemotherapy is performed after surgery,adjuvant chemotherapy plan and frequency,etc.Among these 189 patients,the Karnofsky score(KPS)was ≥70 points;the age range was between 34-77 years old,and they were divided into two groups: 97 cases(51.3%)of ≤60years old,92 cases of >60 years old(48.7%);69 female patients(36.5%),120 male patients(63.5%).According to the results of endoscopy,the primary tumor of the esophagus was divided into 24 cases(12.7%)in the upper thoracic section of the esophagus,114 cases in the middle thoracic section(60.3%),and 51 cases in the lower thoracic section(27.0%);Time,divided into 3 groups: <8 weeks is the first group,8-12 weeks is the second group,>12 weeks is the third group;According to the 8th edition of TNM staging standard for esophageal cancer,it was divided into 4 groups of stage IIA,IIB,IIIA,and IIIB,of which 36 cases were in stage IIA(19.0%),76 cases were in stage IIB(40.2%),and 8 cases were in stage IIIA.(4.2%),69 cases(36.6%)of stage IIIB;according to the depth of pathological tumor invasion,they were divided into T1,T2,and T3 into 3 groups,of which T1 was 4 cases(2.1%),T2 was 47 cases(24.9%),T3 was 138 cases(73.0%).According to the number of postoperative pathological lymph node metastasis,they were divided into N1,N2,N3 3 groups,of which N1 was 108 cases(57.1%),N2 was 58 cases(30.7%),and N3 was 23 cases(12.2%).The patients who met the criteria were enrolled in the group.There were 107 patients(56.6%)in the surgery-only group(S),82 patients(43.4%)in the postoperative chemotherapy group(S+C),and chemotherapy regimens in the chemotherapy group In order to adopt a two-drug combination plan including "platinum" : 4-6 courses of fluorouracil+platinum and tegafur+platinum were the main regimens.Use SPSS23.0 statistical software for statistical analysis: Kaplan-Meier method for survival analysis,Log-rank method for single factor analysis,and Cox regression analysis for multivariate prognostic analysis.P<0.05 indicates that the difference is statistically significant.Results: The follow-up of 189 cases in the whole group ended in January2021,and 10 cases were lost to follow-up.The follow-up rate was 94.7%.The1-year and 2-year overall survival rates of the whole group were 80.4% and55.6%,respectively.The 1-year and 2-year progression-free survival rates were 74.6% and 47.6%,respectively.The median overall survival time and the median progression-free survival time were 25.8 months and 21.8 months,respectively.During the follow-up of the chemotherapy group,no death was found due to adverse reactions of chemotherapy.Univariate analysis and progression-free survival(DFS)prognostic factors related to survival include:the depth of tumor invasion(T stage),the number of lymphatic metastases(N stage),postoperative pathological stage,postoperative adjuvant chemotherapy or not,there are statistical differences(P<0.05).There was no significant difference in gender,age,tumor location,and the start time of chemotherapy after the anastomotic fistula healed,and there was no significant correlation with DFS(P>0.05).Univariate analysis and overall survival(OS)prognostic factors related to survival are: the number of lymphatic metastases(N staging),postoperative pathological staging,and whether adjuvant chemotherapy is given after surgery has statistically significant differences(P<0.05).Gender,age,tumor location,tumor invasion depth(T stage),the start time of chemotherapy after anastomotic leakage was not statistically different,and there was no significant correlation with prognostic survival(P>0.05).The age,gender,tumor location,tumor invasion depth(T stage),number of lymphatic metastases(N stage),postoperative pathological stage,start time of chemotherapy after anastomotic leakage healing,and whether adjuvant chemotherapy is used after surgery are included in DFS Cox regression.Factor analysis showed that postoperative pathological staging(P=0.000<0.05)and postoperative chemotherapy(P=0.000<0.05)were independent prognostic factors for DFS in patients with anastomotic leakage after esophageal squamous cell carcinoma.The age,gender,tumor location,tumor invasion depth(T stage),number of lymphatic metastases(N stage),postoperative pathological stage,start time of chemotherapy after anastomotic leakage healing,and whether adjuvant chemotherapy is used after surgery are included in OS Cox regression.Factor analysis showed that postoperative pathological staging(P=0.000<0.05)and postoperative chemotherapy(P=0.000<0.05)were independent prognostic factors for postoperative OS in patients with anastomotic leakage after esophageal squamous cell carcinoma.Conclusions:1.Adjuvant chemotherapy is an independent prognostic factor for DFS and OS in patients with anastomotic fistula after surgery for stage II and III esophageal squamous cell carcinoma.The later the stage,the worse the patient’s prognosis.2.Postoperative adjuvant chemotherapy is an independent prognostic factor of DFS and OS in patients with anastomotic leakage after stage II and III esophageal squamous cell carcinoma.Postoperative chemotherapy can prolong the disease-free survival and overall survival of patients.3.Proper treatment delay caused by anastomotic fistula after esophageal cancer surgery will not significantly affect the patient’s progression-free survival and overall survival prognosis,but treatment delay may increase the risk of tumor recurrence and metastasis.Therefore,it is recommended to treat esophageal cancer anastomotic fistula Add adjuvant chemotherapy after healing. |
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