Abstract：
BACKGROUND: Second primary esophageal cancer often develops in patients with head and neck cancer, and esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. However, the clinical outcomes of these patients have yet to be examined in a multicenter setting.
METHODS: We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL.
RESULTS: Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30 days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11-70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64-3.29; P = 0.381; Ivor-Lewis as the reference).
CONCLUSIONS: In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.
METHODS: We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL.
RESULTS: Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30 days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11-70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64-3.29; P = 0.381; Ivor-Lewis as the reference).
CONCLUSIONS: In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.
摘要：
背景：第二原发性食管癌通常发生在头颈部癌患者中，对于有咽喉全切术(TPL)病史的患者进行食管切除术是一项挑战.然而,这些患者的临床结局尚未在多中心环境中进行检查.
方法：我们在全国范围内对62例因TPL病史而接受食管癌切除术的患者的手术结果进行了评估。
结果：在32例（51.6%）和30例（48.4%）患者中进行了Ivor-Lewis和McKeown食管切除术，分别。术后,23例（37.1%）出现严重并发症，7例患者(11.3%)在30天内需要再次手术。13例(21.0%)和16例(25.8%)患者发生肺炎和吻合口漏,分别。McKeown组的吻合口漏发生率高于Ivor-Lewis组（46.7％vs.6.2%,P<0.001)。McKeown组吻合口漏的调整比值比为9.64（95％置信区间（CI），2.11-70.82,P=0.008)。同时,两组的5年总生存率相当(Ivor-Lewis为41.8%,McKeown为42.7%),调整后的总生存期风险比为1.44(95%CI,0.64-3.29;P=0.381;Ivor-Lewis为参考).
结论：在我们的队列中，McKeown术后吻合口漏的发生率高于Ivor-Lewis食管切除术,McKeown组近一半的患者出现渗漏。在肿瘤学和技术上可行的情况下，Ivor-Lewis食管切除术是减少吻合口漏的首选方法。
方法：我们在全国范围内对62例因TPL病史而接受食管癌切除术的患者的手术结果进行了评估。
结果：在32例（51.6%）和30例（48.4%）患者中进行了Ivor-Lewis和McKeown食管切除术，分别。术后,23例（37.1%）出现严重并发症，7例患者(11.3%)在30天内需要再次手术。13例(21.0%)和16例(25.8%)患者发生肺炎和吻合口漏,分别。McKeown组的吻合口漏发生率高于Ivor-Lewis组（46.7％vs.6.2%,P<0.001)。McKeown组吻合口漏的调整比值比为9.64（95％置信区间（CI），2.11-70.82,P=0.008)。同时,两组的5年总生存率相当(Ivor-Lewis为41.8%,McKeown为42.7%),调整后的总生存期风险比为1.44(95%CI,0.64-3.29;P=0.381;Ivor-Lewis为参考).
结论：在我们的队列中，McKeown术后吻合口漏的发生率高于Ivor-Lewis食管切除术,McKeown组近一半的患者出现渗漏。在肿瘤学和技术上可行的情况下，Ivor-Lewis食管切除术是减少吻合口漏的首选方法。
