Thoracic endovascular aortic repair for esophageal cancer invading the thoracic aorta: a questionnaire survey study
Thoracic endovascular aortic repair for esophageal cancer invading the thoracic aorta: a questionnaire survey study
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DOI：
10.1007/s10388-019-00696-7
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发表时间：
2020-01-01
期刊：
影响因子：
2.4
通讯作者：
Matsubara, Hisahiro
中科院分区：
文献类型：
--
作者：
Watanabe, Masayuki;Nakajima, Masanobu;Matsubara, Hisahiro
背景局部晚期食管癌偶尔会侵犯主动脉，食管-主动脉瘘出血可导致猝死。胸主动脉腔内修复术（TEVAR）可在此类情况下实现止血，预防性TEVAR可预防治疗期间发生致命性出血事件。然而，其在日本的疗效尚未得到评估。本研究旨在阐明TEVAR在食管癌patient.Methods的临床意义，日本食管学会进行了一项问卷调查，针对授权或半授权的成员机构的授权研究所委员会认证的食管外科医生。从19个研究所确定了接受食管癌TEVAR的患者。使用问卷调查获得患者人口统计学、治疗和生存率数据。采用Kaplan-Meier方法进行生存分析，比较TEVAR治疗出血和术前预防的患者的生存率差异。结果41例患者中，20例患者因食管主动脉瘘出血或即将出血而接受TEVAR治疗，而21例患者接受TEVAR作为术前预防。出血或即将出血组TEVAR后的中位生存时间为135天，术前预防组为378天。18例患者在TEVAR后接受了食管切除术。围手术期未观察到出血事件。食管癌切除术患者的中位生存期为373天。结论TEVAR是一种有效的方法来控制危及生命的出血食管-主动脉瘘，并有助于延长患者的生存局部晚期食管癌侵犯主动脉。
Background Locally advanced esophageal cancer occasionally invades the aorta, and hemorrhage from the esophagoaortic fistula can cause sudden death. Thoracic endovascular aortic repair (TEVAR) enables hemostasis in such cases, and prophylactic TEVAR can prevent fatal hemorrhagic events during treatment. However, its efficacy in Japan has not been evaluated. This study aimed to clarify the clinical significance of TEVAR in esophageal cancer patients.Methods The Japan Esophageal Society conducted a questionnaire survey targeting authorized or semi-authorized member institutes of the Authorized Institutes for Board Certified Esophageal Surgeons. Patients who underwent TEVAR for esophageal cancer were identified from 19 institutes. Data on patient demographics, treatment performed, and survival rate were obtained using the questionnaire. The Kaplan-Meier method was used for survival analysis and to compare differences in survival rates between those who underwent TEVAR for hemorrhage and those for preoperative prophylaxis.Results Of the 41 patients identified, 20 patients underwent TEVAR for hemorrhage or impending hemorrhage from the esophagoaortic fistula, while 21 patients underwent TEVAR as preoperative prophylaxis. The median survival time after TEVAR was 135 days in the hemorrhage or impending hemorrhage group and 378 days in the preoperative prophylaxis group. Eighteen patients underwent esophagectomy after TEVAR. No hemorrhagic event was observed during the perioperative period. The median survival time of the patients who underwent esophagectomy was 373 days. Some patients who achieved R0 resection obtained long-term survival.Conclusion TEVAR is an efficacious modality to control a life-threatening hemorrhage from esophagoaortic fistula and helps to prolong the survival of patients with locally advanced esophageal cancer invading the aorta.