Zhongguo quanke yixue (Oct 2023)
Improvement of Nutritional Status of Elderly Patients with Severe Obstruction Esophageal Carcinoma by Image-guided Photodynamic Therapy
Abstract
Background Esophageal cancer is one of the most aggressive gastrointestinal tumors. Advanced esophageal carcinoma is mainly associated with dysphagia. Most elderly patients with severe obstruction esophageal carcinomacannot tolerate anesthesia and invasive treatment due to comorbidities, while the failure to improve dysphagia in the short term will seriously affect the nutritional status, life quality and prognosis of patients. Objective To explore the safety and efficacy of image-guided photodynamic therapy (IGPDT) under local anesthesia for short-term improvement of obstruction and nutritional status in elderly patients with severe obstruction esophageal carcinoma. Methods A total of 24 elderly patients with severe obstruction esophageal carcinoma admitted to Hebei General Hospital from March 2020 to December 2021 were selected for IGPDT in the prospective, single-arm, self-control study. The upper boundary of the lesion was located by endoscopy and marked with metal tissue clips, the lower boundary of the lesion was located by CT and esophagography before treatment. During the treatment, the fiber of laser treatment was delivered to the lesion site under the guidance of X-ray fluoroscopy during treatment. The Stooler dysphagia score was evaluated before, 1 week and 1 month after operation. The nutritional status of patients was evaluated by nutritional risk screening 2002 (NRS 2002) score, hemoglobin, BMI, albumin and prealbumin before and 2 months after operation. The swallowing quality of life scale (SWAL-QOL) was used to evaluate the quality of life in patients. Results All patients achieved partial response (PR) at 1 month postoperative efficacy evaluation. The Stooler dysphagia scores at 1 week and 1 month after IGPDT were significantly lower than that before operation (P<0.001). BMI, albumin and prealbumin at 2 months after operation were significantly increased than that before operation (P<0.05). The total score and scores of different dimensions in SWAL-QOL at 2 months after operation were significantly higher than those before operation, including psychological burden, appetite, eating time, fear of eating and swallowing symptoms (P<0.05). 92% (22/24) of the patients presented with grade 1-2 mild fever, and most of them could be relieved on their own. 83% (20/24) of the patients presented with grade 1-2 pain at the site of operation at 1-2 days after surgery but could be relieved by themselves. No esophageal fistula occurred in all patients during the operation, and no serious adverse effects of grade 3 or above occurred. Conclusion IGPDT has the advantages of easy operation, excellent efficacy and safety, and short-term improvement of nutritional status in patients, which can be used as a novel photodynamic therapy for patients with severe obstruction esophageal carcinoma cannot be passed by endoscopy.
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