Evaluating the Impact of Mental Disorders on Outcomes Following Esophagectomy for Cancer: A Systematic Review and Meta-Analysis

IF 1.6 4区医学 Q3 SURGERY

ANZ Journal of Surgery Pub Date : 2025-07-16 DOI:10.1111/ans.70255

Dimitrios Papaconstantinou, Theano Perri, Nikolaos Christodoulou, Orestis Lyros, Dimosthenis Chrysikos, Efstathia Liatsou, Georgios D. Lianos, Michail Mitsis, Vasileios Tatsis, Ioannis Karavokyros, Dimitrios Schizas

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Abstract

Background

Esophageal cancer, the sixth leading cause of cancer-related deaths globally, imposes significant physical and psychological burdens on patients. Psychiatric comorbidities, such as anxiety and depression, are prevalent among esophagectomy patients and may adversely affect postoperative outcomes, quality of life, and survival. However, their clinical impact remains understudied and heterogeneous in existing literature.

Objectives

This systematic review and meta-analysis evaluates the prevalence and clinical significance of perioperative mental disorders in esophageal cancer surgery, assessing their association with postoperative outcomes.

Data Sources

A comprehensive search of Medline, Embase, CINAHL, CENTRAL, and Web of Science was conducted from inception to March 2025. (Keywords included “esophageal cancer,” “esophagectomy,” “anxiety,” “depression”).

Review Methods

PRISMA-guided analysis included 11 studies (n = 24 411 patients). Studies reporting preoperative psychiatric comorbidities or postoperative mental disorders (PMD) were eligible. Risk of bias was assessed using ROBINS-I. Random-effects meta-analyses pooled mortality risk, PMD incidence, and associated risk factors.

Results

Preoperative psychiatric comorbidities (11.8%–28.8%) increased mortality risk by 33% (RR 1.33, 95% CI 1.15–1.55, p < 0.001). PMD incidence was 29.8% (95% CI 21.2%–38.4%), with anxiety being the most common (29.5%). Key risk factors included stage III disease (OR 3.2, 95% CI 1.66–6.2), postoperative complications (OR 2.32, 95% CI 1.55–3.49), female gender (OR 1.35, 95% CI 1.07–1.69), and higher Charlson Comorbidity Index (OR 1.04, 95% CI 1.01–1.06).

Conclusions

Mental disorders significantly impact esophagectomy outcomes, elevating mortality, and complicating recovery. Proactive screening and multidisciplinary mental health support are warranted, particularly for high-risk patients.

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评估精神障碍对食管癌切除术后预后的影响：一项系统回顾和荟萃分析。

背景：食管癌是全球癌症相关死亡的第六大原因，给患者带来了巨大的生理和心理负担。精神合并症，如焦虑和抑郁，在食管切除术患者中普遍存在，并可能对术后结果、生活质量和生存产生不利影响。然而，在现有的文献中，它们的临床影响仍未得到充分的研究和多样化。目的：本系统综述和荟萃分析评估食管癌手术围手术期精神障碍的患病率和临床意义，评估其与术后预后的关系。数据来源：综合检索Medline， Embase， CINAHL， CENTRAL和Web of Science从成立到2025年3月。（关键词包括“食管癌”、“食管切除术”、“焦虑”、“抑郁”）。回顾方法：prisma引导分析纳入11项研究（n = 24411例患者）。报告术前精神合并症或术后精神障碍（PMD）的研究符合条件。使用ROBINS-I评估偏倚风险。随机效应荟萃分析汇集了死亡风险、PMD发病率和相关危险因素。结果：术前精神合并症（11.8%-28.8%）使死亡风险增加33% （RR 1.33, 95% CI 1.15-1.55, p）。结论：精神障碍显著影响食管切除术结果，提高死亡率，并使康复并发症。主动筛查和多学科精神卫生支持是必要的，特别是对高危患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ANZ Journal of Surgery 医学-外科

CiteScore

2.50

自引率

11.80%

发文量

720

审稿时长

2 months

期刊介绍： ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.