Esophagus : official journal of the Japan Esophageal Society · 2025
Impact of surgical approaches on postoperative body weight and nutrition outcomes in cervical esophageal cancer.
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Fuse Masahiro, Fujiwara Hisashi, Ogo Taichi, Kawada Kenro, Okuno Keisuke, Tanioka Toshiro, Haruki Shigeo, Tokunaga Masanori, Kinugasa Yusuke
Аннотация
BACKGROUND: Cervical esophageal cancer surgery can lead to postoperative gastric issues, impairing nutritional quality of life. This study aimed to compare larynx-preserving cervical esophagectomy with free jejunal graft interposition and subtotal esophagectomy with gastric pull-up reconstruction in terms of both short-term and long-term outcomes, with a particular focus on short-term nutritional parameters.
METHODS: This single-institution, retrospective study included 87 patients who underwent surgery for cervical esophageal cancer between January 2011 and December 2021. Patient characteristics and postoperative outcomes were analyzed to compare larynx-preserving cervical esophagectomy with free jejunal graft interposition (CE group, n = 26) and subtotal esophagectomy with gastric pull-up reconstruction (SE group, n = 61); furthermore, nutritional parameters were analyzed in patients from both groups who could be followed up for > 1 year postoperatively (nutritional CE group, n = 20; nutritional SE group, n = 41).
RESULTS: Demographic differences between the CE and SE groups were not significant. The postoperative complication rates, length of hospital stay, and mortality rates were similar between the groups. Survival analysis showed no significant differences in 5-year overall survival (69.2% vs. 62.8%, p = 0.554) or recurrence-free survival (54.5% vs. 55.7%, p = 0.933) between the nutritional CE and SE groups. Changes in bodyweight and Onodera's prognostic nutritional index were less negative in the nutritional CE group (-0.4% vs. -15.2%, p < 0.001, and 0.68% vs. -2.68%, p = 0.028, respectively).
CONCLUSION: Larynx-preserving cervical esophagectomy with free jejunal graft interposition has a significant advantage in improving postoperative nutritional status without increasing complications or compromising long-term outcomes, compared to subtotal esophagectomy with gastric pull-up reconstruction. Therefore, it is a viable initial surgical option for patients with resectable cervical esophageal cancer who are candidates for radical resection with cervical esophagectomy alone.
METHODS: This single-institution, retrospective study included 87 patients who underwent surgery for cervical esophageal cancer between January 2011 and December 2021. Patient characteristics and postoperative outcomes were analyzed to compare larynx-preserving cervical esophagectomy with free jejunal graft interposition (CE group, n = 26) and subtotal esophagectomy with gastric pull-up reconstruction (SE group, n = 61); furthermore, nutritional parameters were analyzed in patients from both groups who could be followed up for > 1 year postoperatively (nutritional CE group, n = 20; nutritional SE group, n = 41).
RESULTS: Demographic differences between the CE and SE groups were not significant. The postoperative complication rates, length of hospital stay, and mortality rates were similar between the groups. Survival analysis showed no significant differences in 5-year overall survival (69.2% vs. 62.8%, p = 0.554) or recurrence-free survival (54.5% vs. 55.7%, p = 0.933) between the nutritional CE and SE groups. Changes in bodyweight and Onodera's prognostic nutritional index were less negative in the nutritional CE group (-0.4% vs. -15.2%, p < 0.001, and 0.68% vs. -2.68%, p = 0.028, respectively).
CONCLUSION: Larynx-preserving cervical esophagectomy with free jejunal graft interposition has a significant advantage in improving postoperative nutritional status without increasing complications or compromising long-term outcomes, compared to subtotal esophagectomy with gastric pull-up reconstruction. Therefore, it is a viable initial surgical option for patients with resectable cervical esophageal cancer who are candidates for radical resection with cervical esophagectomy alone.