Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy
Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy
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DOI：
10.1067/mtc.2002.119070
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发表时间：
2002-01-01
影响因子：
6
通讯作者：
Walsh, GL
中科院分区：
文献类型：
--
作者：
Swisher, SG;Wynn, P;Walsh, GL
目的：一些患者和肿瘤学家选择用明确的化疗和放疗来治疗局限性食管癌，而不是手术。这些患者中有一部分局部复发而无远处转移，因此除了挽救性食管切除术外没有其他治疗选择。方法：回顾1987年至2000年md安德森癌症中心（M.D. Anderson Cancer Center）进行补救性食管切除术的经验（化疗放疗后补救性组13例），并与术前化疗放疗后4 ~ 6周计划行食管切除术的患者（术前化疗放疗组99例）进行比较。结果：与术前放化疗组相比，放化疗后抢救组术后并发症发生率增加：机械通气（9.0天vs 3.3天，P = 0.08）、重症监护病房住院时间（11.2天vs 5.1天，P = 0.07）、住院时间（29.4天vs 18.4天，P = 0.03）、吻合口漏率（5/13 [39%]vs 7/99 [7%], P = 0.005）。手术死亡率（30天内）也趋于增加，但无统计学意义（2/13 [15%]vs 6199 [6%], P = 0.2）。在一部分患者中，补救性食管切除术导致了长期生存率（25%的5年生存率）。挽救性食管切除术后生存率的提高与早期病理分期（T1 N0, T2 N0）、复发时间延长和R0手术切除有关。结论：与术前放化疗后进行计划食管切除术的患者相比，在明确放化疗后肿瘤复发的患者行补救性食管切除术的发病率、死亡率和住院率更高。尽管如此，在这个组中可以实现长期生存，应该考虑在有经验的中心对精心挑选的患者进行这种治疗。
Objectives: Some patients and oncologists choose to treat localized esophageal cancer with definitive chemotherapy and radiation therapy rather than surgery. A subset of these patients have local relapse without distant metastases and therefore have no other curative intent treatment option but salvage esophagectomy.Methods: We reviewed our experience with salvage esophagectomy from 1987 to 2000 at M.D. Anderson Cancer Center (n = 13, salvage after chemotherapy and radiotherapy group) and compared the data with those of patients receiving esophagectomy in a planned fashion 4 to 6 weeks after preoperative chemotherapy and radiation therapy (n = 99, preoperative chemotherapy and radiotherapy group).Results: Increases in morbidity were seen after resection in the salvage after chemotherapy and radiotherapy group relative to the preoperative chemotherapy and radiotherapy group: mechanical ventilation (9.0 days vs 3.3 days, P = .08), intensive care unit stay (11.2 days vs 5.1 days, P = .07), hospital stay (29.4 days vs 18.4 days, P = .03), and anastomotic leak rates (5/13 [39%] vs 7/99 [7%], P = .005). Operative mortality (within 30 days) also tended to be increased statistically nonsignificantly (2/13 [15%] vs 6199 [6%], P = .2). Salvage esophagectomy resulted in long-term survival (25% 5-year survival) in a subset of patients. Improved survival after salvage esophagectomy was associated with early pathologic stage (T1 N0, T2 N0), prolonged time to relapse, and R0 surgical resection.Conclusion: Patients who undergo salvage esophagectomy for relapse of tumor after definitive chemoradiation therapy have increased morbidity, mortality, and hospital use relative to patients undergoing planned esophagectomy after preoperative chemoradiation. Nevertheless, long-term survival can be achieved in this group, and such treatment should be considered for carefully selected patients at an experienced center.