Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?
Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?
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DOI：
10.21037/jtd.2017.12.108
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发表时间：
2018-02-01
影响因子：
2.5
通讯作者：
Wang, Qun
中科院分区：
文献类型：
--
作者：
Tang, Han;Zheng, Hao;Wang, Qun
背景资料：很少有研究报告微创食管切除术（MIE）治疗新辅助放化疗（nCRT）后食管鳞状细胞癌（ESCC）患者的结局。本研究的目的是探讨nCRT加MIE（RM）策略治疗局部晚期可切除ESCC的可行性和有效性。方法：本回顾性研究纳入了2010年至2016年在我院接受新辅助治疗后行手术切除的175例ESCC患者。结果：RM组76例（43.4%），CM组42例（24%），CO组57例（32.6%）;与CO入路相比，RM或CM入路的手术时间更短（188 +/-39，185 +/-37 vs. 209 +/-45分钟，P = 0.004，P = 0.009），失血量更少（124 +/-88，122 +/-79 vs. 166 +/-92 mL，P = 0.001，P = 0.003）。RM和CM入路的术后非手术并发症风险有降低的趋势[比值比（OR）0.45，0.200 - 1.040; P = 0.062; OR 0.41，0.150 - 1.160; P = 0.093]。所有组之间的30天和90天死亡率无差异。与CM或CO入路相比，RM入路更容易实现病理完全消退（27.6%vs4.8%，1.8%，P = 0.001，P = 0.001），淋巴结转移率更低（25.0%vs57.1%，61.4%，P = 0.001，P = 0.001）。生存分析显示，RM术式的总生存率明显高于CM术式和CO术式（P = 0.098，P = 0.166）。结论：RM术式是治疗局部晚期可切除食管鳞癌的一种安全有效的方法。
Background: Few studies reported the outcomes of minimally invasive esophagectomy (MIE) in treating patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT). The aim of the study was to investigate the feasibility and efficacy of nCRT plus MIE (RM) strategy in treating locally advanced resectable ESCC.Methods: This retrospective study included 175 patients with ESCC undergoing surgical resection after neoadjuvant therapy in our institution from 2010 to 2016. Patients were stratified into three groups: RM, [neoadjuvant chemotherapy (nCT) plus MIE] (CM) and [nCT plus open esophagectomy (OE)] (CO).Results: Seventy-six (43.4%), 42 (24%) and 57 (32.6%) patients received RM, CM and CO approach, respectively. Compared with CO approach, RM or CM approach had shorter operation duration (188 +/- 39, 185 +/- 37 vs. 209 +/- 45 minutes, P=0.004, P=0.009) and less blood loss (124 +/- 88, 122 +/- 79 vs. 166 +/- 92 mL, P=0.001, P=0.003). There was a trend with lower risk of postoperative non-surgical complications in RM and CM approach [odds ratio (OR) 0.45, 0.200-1.040; P=0.062; OR 0.41, 0.150-1.160; P=0.093]. There were no differences in 30- and 90-day mortality among all groups. RM approach was more likely to achieve pathological complete regression (27.6% vs. 4.8%, 1.8%, P=0.001, P=0.001) and fewer lymph node metastasis (25.0% vs. 57.1%, 61.4%, P=0.001, P=0.001) than CM or CO approach. Survival analysis revealed a potential trend towards improved overall survival in RM approach compared with CM or CO approach (P=0.098, P=0.166).Conclusions: RM approach was a safe and efficient strategy in treating locally advanced resectable ESCC.