Advances in the management of postoperative gastroesophageal reflux in patients with esophageal cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Xue ¹ ,  LUO Lei ² , HAN Yongtao ³ , MIAO Yan ³

1. School of Medicine, University of Electronic Science and Technology, Chengdu, 610054, P. R. China;
2. General Affairs Department, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, P. R. China;
3. First Ward of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, P. R. China;

Corresponding author：

LUO Lei, Email: 43369334@qq.com

Keywords：

Esophageal cancer; gastroesophageal reflux; esophagectomy; review

DOI：

10.7507/1007-4848.202411049

Video：

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[Abstract] Gastroesophageal reflux (GER) is one of the most common postoperative complications in patients with esophageal cancer, which mainly manifests as heartburn sensation and acid reflux, and has a serious impact on patients' postoperative recovery and quality of life. This article reviews five aspects of postoperative reflux: main manifestations, hazards, assessment tools, influencing factors, and nonpharmacological interventions, in order to enhance the awareness of clinical healthcare professionals in recognizing and managing patients with postoperative reflux, and to provide a reference for carrying out the assessment and developing the intervention program.

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1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA-Cancer J Clin, 2024, 74(3): 229-263.
2. An L, Zheng R, Zeng H, et al. The survival of esophageal cancer by subtype in China with comparison to the United States. Int J Cancer, 2023, 152(2): 151-161.
3. Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2019, 269(2): 291-298.
4. He Y, Wu YY, Wei W, et al. Dietary habits and nutrition status in esophageal cancer patients after esophageal reconstruction. J Thorac Dis, 2024, 16(2): 1118-1127.
5. Park S, Kang CH, Lee HJ, et al. Prevalence and risk factors of reflux after esophagectomy for esophageal cancer. J Thorac Dis, 2020, 12(3): 558-567.
6. Nakahara Y, Yamasaki M, Miyazaki Y, et al. Reflux after esophagectomy with gastric conduit reconstruction in the posterior mediastinum for esophageal cancer: Original questionnaire and EORTC QLQ-C30 survey. Dis Esophagus, 2018, 31(7).
7. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. Clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol, 2022, 117(1): 27-56.
8. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. Am J Gastroenterol, 2006, 101(8): 1900-1920; quiz 1943.
9. Kadoya K, Tanaka T, Mori N, et al. Changes in acidity levels in the gastric tube after esophagectomy for esophageal cancer. Kurume Med J, 2023, 68(2): 91-96.
10. Iizuka T, Suzuki Y, Kikuchi D, et al. Columnar epithelium morphology after esophagectomy: Clinical insight into the development of Barrett's esophagus. Esophagus, 2020, 17(4): 392-398.
11. 吕宾. 非心源性胸痛的评估和处理. 胃肠病学, 2022, 27(3): 129-134.Lyu B. Evaluation and management of noncardiac chest pain. Chin J Gastro, 2022, 27(3): 129-134.
12. Richter JE, Rubenstein JH. Presentation and epidemiology of gastroesophageal reflux disease. Gastroenterology, 2018, 154(2): 267-276.
13. Markar SR, Zaninotto G, Castoro C, et al. Lasting symptoms after esophageal resection (LASER): European multicenter cross-sectional study. Ann Surg, 2022, 275(2): e392-e400.
14. 赵雨晴, 李惠霞, 孙雪影, 等. 食管癌病人术后早期反流与相关症状的轨迹研究. 护理研究, 2023, 37(14): 2519-2524.Zhao YQ, Li HX, Sun XY, et al. A trajectory study of early postoperative reflux and associated symptoms in patients with esophageal cancer. Chin Nurs Res, 2023, 37(14): 2519-2524.
15. Blazeby JM, Conroy T, Hammerlid E, et al. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer, 2003, 39(10): 1384-1394.
16. Lagergren P, Johar AM, Lagergren J. Validation of the reflux scale in the European Organisation for Research and Treatment of Cancer QLQ-OES18. Eur J Cancer, 2013, 49(5): 1097-1103.
17. 李惠霞, 杨华, 郎文静, 等. 量表EORTC QLQ-OES18在中国食管癌患者中的有效性验证. 重庆医学, 2016, 45(21): 2969-2972.Li HX, Yang H, Lang WJ, et al. Validation of the scale EORTC QLQ-OES18 in Chinese patients with esophageal cancer. Chongqing Med J, 2016, 45(21): 2969-2972.
18. Lagergren P, Fayers P, Conroy T, et al. Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-OG25, to assess health-related quality of life in patients with cancer of the oesophagus, the oesophago-gastric junction and the stomach. Eur J Cancer, 2007, 43(14): 2066-2073.
19. Tomaszewski KA, Püsküllüoğlu M, Biesiada K, et al. Validation of the Polish version of the EORTC QLQ-C30 and the QLQ-OG25 for the assessment of health-related quality of life in patients with esophagi-gastric cancer. J Psychosoc Oncol, 2013, 31(2): 191-203.
20. Lagergren P, Johar A, Rosenlund H, et al. Severe reflux, sleep disturbances, and health-related quality of life after esophageal cancer surgery. J Cancer Surviv, 2021, 15(6): 818-824.
21. Lagergren P, Johar A, Liu Y, et al. Severe reflux and symptoms of anxiety and depression after esophageal cancer surgery. Cancer Nurs, 2022, 45(4): 280-286.
22. Nakamura M, Kido Y, Egawa T. Development of a 32-item scale to assess postoperative dysfunction after upper gastrointestinal cancer resection. J Clin Nurs, 2008, 17(11): 1440-1449.
23. Yano M, Motoori M, Tanaka K, et al. Prevention of gastroduodenal content reflux and delayed gastric emptying after esophagectomy: Gastric tube reconstruction with duodenal diversion plus Roux-en-Y anastomosis. Dis Esophagus, 2012, 25(3): 181-187.
24. Yano M, Sugimura K, Miyata H, et al. Randomized comparison of gastric tube reconstruction with and without duodenal diversion plus Roux-en-Y anastomosis after esophagectomy. Ann Surg, 2020, 272(1): 48-54.
25. Huang HC, Chang YJ, Tseng YL, et al. Effect of head-of-bed elevation on nocturnal reflux symptoms of esophageal cancer patients with esophagectomy and reconstruction. Cancer Nurs, 2021, 44(3): 244-250.
26. Lee MK, Yost KJ, Pierson KE, et al. Patient-reported outcome domains for the esophageal CONDUIT report card: A prospective trial to establish domains. Health Qual Life Outcomes, 2018, 16(1): 197.
27. Lee MK, Abou Chaar MK, Blackmon SH, et al. PRO-Angoff method for remote standard setting: Establishing clinical thresholds for the upper digestive disease tool. J Patient Rep Outcomes, 2024, 8(1): 30.
28. Yang YS, Shang QX, Yuan Y, et al. Comparison of long-term quality of life in patients with esophageal cancer after Ivor-Lewis, Mckeown, or Sweet esophagectomy. J Gastrointest Surg, 2019, 23(2): 225-231.
29. 王毅, 罗雷, 杨彦辉, 等. 两种不同消化道重建吻合方式在胸腹腔镜食管癌切除术中的临床疗效对比分析. 中国胸心血管外科临床杂志, 2023, 30(12): 1743-1748.Wang Y, Luo L, Yang YH, et al. Comparative analysis of the clinical efficacy of two different methods of digestive tract reconstruction and anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(12): 1743-1748.
30. Chen B, Xia P, Tang W, et al. Which anastomotic techniques is the best choice for cervical esophagogastric anastomosis in esophagectomy? A Bayesian network meta-analysis. J Gastrointest Surg, 2023, 27(2): 422-432.
31. Aly A, Jamieson GG. Reflux after oesophagectomy. Br J Surg, 2004, 91(2): 137-141.
32. Sakai M, Sohda M, Miyazaki T, et al. Impact of the level of anastomosis on reflux esophagitis following esophagectomy with gastric tube reconstruction. World J Surg, 2017, 41(3): 804-809.
33. Horikawa M, Oshikiri T, Kato T, et al. Efficacy and postoperative outcomes of laparoscopic retrosternal route creation for the gastric conduit: Propensity score-matched comparison to posterior mediastinal reconstruction. Ann Surg Oncol, 2023, 30(7): 4044-4053.
34. 王兵, 闫沛静, 聂洪鑫, 等. 管状胃与全胃重建食管治疗食管癌疗效的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2020, 27(5): 548-557.Wang B, Yan PJ, Nie HX, et al. Clinical effect of tubular stomach and whole stomach reconstruction on esophageal carcinoma treatment: A systematic review and meta-analysis. Chin J Clin Thorac Cardiovasc Surg, 2020, 27(5): 548-557.
35. 施庆彤, 范黄新, 刁亚利. 管状胃宽度与食管癌术后抗胃食管反流的临床研究. 中华胸部外科电子杂志, 2016, 3(1): 25-28.Shi QT, Fan HX, Diao YL. Clinical research of stomach tube width and gastroesophageal reflux after esophagectomy for esophageal cancer. Chin J Thorac Surg (Electronic Edition), 2016, 3(1): 25-28.
36. Park SY, Park B, Jeon YJ, et al. Comparison of the oncologic outcomes for patients with middle to lower esophageal squamous cell carcinoma undergoing surgical treatment using the Ivor-Lewis or McKeown operation. Ann Surg Oncol, 2024, 31(12): 7750-7758.
37. 查鹏, 梁正. 微创食管切除术的发展历程和进展. 中国微创外科杂志, 2020, 20(1): 62-65.Zha P, Liang Z. History and progress of minimally invasive esophagectomy. Chin J Min Inv Surg, 2020, 20(1): 62-65.
38. Gu HY, Luo J, Qiang Y. Postoperative complications analysis of circular stapled versus linear stapled anastomosis for patients undergoing esophagectomy: A systematic review and meta-analysis. J Cardiothorac Surg, 2023, 18(1): 242.
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