Clinical outcomes

We analyzed the patients’ characteristics: including age, sex, preoperative complications, tumor location, and pathological staging. We analyzed surgery-related indicators, such as drainage duration, time of first postoperative flatus, frequency of sputum suction with a fiberbronchoscope, length of hospital stay, pulmonary infection, and anastomotic leakage. And the criteria for removing thoracic drain included re-expand of the lung, drainage volume less than 150 mL/day, no bloody or chylous-like drainage, adequate control of pneumonia, absence of massive pleural effusion. The presence of pneumonia is defined by new lung infiltrate plus clinical evidence that the infiltrate is of an infectious origin (5,6). The criteria for sputum suction included lack of effective cough, thick and heavy sputum, atelectasis showed by X-rays or CT images.


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We analyzed the patients’ postoperative QOL using the scale established by the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30 V3.0, Chinese Version) (7). Their mental status was assessed using the National Comprehensive Cancer Network-recommended Distress Thermometer (8). A self-evaluation of mental distress, this tool includes 11 items that are scored on a scale ranging from 0 to 10, where 0= no stress and 10= extreme stress.

Statistical analyses

SPSS 20.0 statistics software (SPSS, Inc., Chicago, IL, USA) was used for the analyses. Normally distributed quantitative data with equal variance were analyzed using an independent t-test. The Mann-Whitney test was used for data that were not normally distributed or did not have equal variance. The t-test was used to compare the means of two samples. The χ2 test was used to make comparisons between qualitative data. Comparisons among groups of repeatedly measured data required multivariate analysis of variance. A value of P<0.05 indicated statistical significance.

RESULTS

Patient characteristics and clinical features

A prospective cohort design was used to observe 110 aged patients with esophageal squamous cell carcinoma. There were 55 patients in the observation group (38 men, 17 women; mean ± SD age 67.73±6.69 years; range, 60–86 years) and 55 patients in control group (41 men, 14 women; mean ± SD age 67.00±5.58 years; range 60–85 years). We used Onodera’s prognostic nutritional index (PNI) to evaluate the preoperative nutrition status, which is calculated from baseline clinical parameters, namely, peripheral lymphocyte count and serum albumin (9,10). There was no significant difference in age, sex, preoperative complications, tumor location, PNI value or pathological staging between the two groups (P>0.05). The patients’ characteristics and clinical features are shown in Table 1.

Postoperative clinical outcomes

An independent sample t-test, nonparametric test, or χ2 test was used to define whether there were statistical significances in the postoperative clinical outcomes between the two groups. The results showed significant differences in the duration of thoracic drainage, length of hospital stay, frequency of sputum suction, incidence of pulmonary infection, and incidence of anastomotic leakage (all P<0.05). The times of first flatus and jejunal feeding were earlier in the observation group than the control group. Surgical clinical outcomes are shown in Table 2.

(To view a larger version of Table 2, click here.)

Preoperative and postoperative QOL

As shown in Table 3 and Figure 1, the QOL scores of both groups fell during postoperative week (POW) 1 and then increased during POW 2, reaching a relatively stable condition during POWs 4–8, although they were still lower than the preoperative QOL score. Because the QOLs of different periods comprised qualitative data measured repeatedly, a multivariate analysis of variance was used to conduct the analyses, which indicated no statistical difference in the preoperative QOL between the two groups (P>0.05). In contrast, the QOL was statistically significantly higher in the observation group than in the controls at POWs 1, 2, 4, and 8 (P<0.05).

(To view a larger version of Table 3, click here.)

Preoperative and postoperative mental distress

The mental stress of both groups increased during POW 1 and then decreased at POW 2, finally reaching a relatively stable condition during POWs 4–8, although it was still lower than that preoperatively (Table 4, Figure 2). Because mental stress was measured as qualitative data and was determined repeatedly, multivariate analysis of variance was used to conduct the analysis. It indicated no statistical difference in preoperative mental stress between the two groups (P>0.05), whereas the mental stress of the observation group was significantly lower than that of the controls at POWs 1, 2, 4, and 8 (P<0.05).

(To view a larger version of Table 4, click here.)