Transthoracic esophagectomy results in a radical change in foregut anatomy with multiple consequences for digestive physiology. The aim of this study was to identify factors associated with poor functional outcomes by assessing multiple dimensions of digestive performance and health-related quality of life (HRQL). Patients with cancer-free survival after Ivor Lewis esophagectomy were included. Four functional syndromes (dysphagia, gastroesophageal reflux disease (GERD), delayed gastric conduit emptying (DGCE), and dumping syndrome (DS)) and HRQL were assessed using specifically designed questionnaires. Patient outcomes were compared with healthy controls. Independent factors associated with poor digestive performance were identified through multivariable analysis. Sixty-five postoperative patients and 50 healthy volunteers participated in this study. Compared with controls, patients had worse outcomes for dysphagia, GERD, DS, and HRQL, but not for DGCE. A multivariate analysis showed a significant correlation of reduced digestive performance with ASA score, squamous cell carcinoma, open or hybrid surgical approach, and (neo)adjuvant therapy. In contrast, no individual patient factor was found to be associated with dumping syndrome. Digestive function and HRQL are substantially impaired after Ivor Lewis esophagectomy for cancer. Comorbid patients undergoing multimodal treatment and open access surgery for squamous cell carcinoma have the highest risk of poor functional outcome.
经胸食管切除术会导致前肠解剖结构发生根本性改变，并对消化生理产生多重影响。本研究旨在通过评估消化功能及健康相关生活质量的多维度指标，识别与不良功能结局相关的因素。研究纳入了接受Ivor Lewis食管切除术后无癌生存的患者。采用专门设计的问卷评估四种功能综合征（吞咽困难、胃食管反流病、胃代食管排空延迟及倾倒综合征）及健康相关生活质量。将患者结局与健康对照组进行比较，并通过多变量分析确定与消化功能不良相关的独立因素。本研究共纳入65例术后患者及50名健康志愿者。与对照组相比，患者在吞咽困难、胃食管反流病、倾倒综合征及健康相关生活质量方面结局更差，但胃代食管排空延迟无显著差异。多变量分析显示，消化功能下降与ASA评分、鳞状细胞癌、开放或混合手术方式及（新）辅助治疗显著相关。然而，未发现任何个体患者因素与倾倒综合征存在关联。癌症患者接受Ivor Lewis食管切除术后，消化功能及健康相关生活质量均显著受损。接受多模式治疗及开放手术的鳞状细胞癌合并症患者发生不良功能结局的风险最高。
肿瘤(癌症)患者之家