Published online Feb 6, 2019. doi: 10.12998/wjcc.v7.i3.291
Peer-review started: November 19, 2018
First decision: December 9, 2018
Revised: December 12, 2018
Accepted: December 14, 2018
Article in press: December 15, 2018
Published online: February 6, 2019
Processing time: 70 Days and 18.8 Hours
Esophageal cancer is the second largest digestive tract malignancy after gastric cancer. The surgical procedures for esophageal cancer are constantly improving and innovating. Due to its minimally invasive and precise features, minimally invasive Ivor-Lewis esophagectomy (MIILE) significantly reduces the incidence of complications in patients undergoing surgery. It is superior to traditional open surgery and has gradually become the main surgical procedure for advanced esophageal cancer in clinical treatment.
MIILE also has the disadvantages that need to be overcome. In addition to the disadvantages of high surgical difficulty, MIILE has a relatively high incidence of complications such as postoperative early delayed gastric emptying (DGE). Postoperative DGE is a functional emptying disorder. It will not only affect the enthusiasm of postoperative rehabilitation, but also increase the risk of other complications such as anastomotic leakage. It may lead to patients undergoing secondary surgery. Therefore, it is the current top priority to find out the precise cause of early DGE and provide early intervention.
The present study aimed to compare the differences between patients with postoperative early DGE and those without, in order to explore the influencing factors of postoperative early DGE after MIILE.
A total of 156 patients with esophageal cancer diagnosed at our hospital were recruited. All patients were treated by MIILE. According to the DGE diagnostic criteria, patients were divided into a DGE group if DGE was found in the early postoperative period (within one week). While patients were divided into a control group if DGE was not found in the early postoperative period. Various data of the DGE group and the control group were recorded and compared, and single factor analysis was performed. Multivariate logistic regression analysis was performed to further determine the extent of these factors’ effect on early postoperative DGE. The ROC curve was used to analyze the accuracy of these factors in predicting the early postoperative DGE.
Multivariate logistic regression analysis showed that age, anxiety score, perioperative albumin level, and postoperative fluid volume were the independent factors influencing postoperative early DGE. The receiver operating characteristic curve analysis revealed that the area under the curve (AUC) for anxiety score was 0.720, and the sensitivity and specificity were 80.37% and 65.31%, respectively. The AUC, sensitivity, and specificity for postoperative fluid volume were 0.774, 65.3%, and 77.6%, respectively. Regarding perioperative albumin level, they were 0.758, 97.2%, and 46.9%, respectively. However, studies have shown that the time interval from surgery to enteral nutrition also contributes to the early postoperative DGE, but this study found that the time interval from surgery to enteral nutrition had no significant effect on postoperative early DGE. It implied that our research may have a limited sample size and further research is necessary.
The present study found that advanced age, postoperative anxiety, perioperative albumin level, and postoperative fluid volume were the independent factors influencing postoperative early DGE. These indicators are expected to be used to predict the occurrence of postoperative early DGE.
The findings of this study will help to further guide the care and treatment of postoperative patients, thereby preventing the occurrence of early postoperative DGE, and improving the quality of postoperative life of patients with esophageal cancer.