Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma
Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma
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DOI：
10.1016/j.jtcvs.2008.05.016
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发表时间：
2009-01-01
影响因子：
6
通讯作者：
Kato, Hoichi
中科院分区：
文献类型：
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作者：
Tachimori, Yuji;Kanamori, Norio;Kato, Hoichi
目的：放化疗是食管癌患者和肿瘤学家普遍接受的确定性治疗方法。虽然完全缓解率高，放化疗后短期生存率高，但持续或复发的局部疾病是常见的。挽救性手术是该疾病过程的唯一治愈性治疗选择。本研究评价了高剂量确定性放化疗后食管鳞状细胞癌局部失败的挽救性食管切除术的安全性和价值。方法：我们回顾了59例连续胸段食管鳞状细胞癌患者接受了确定性放化疗后的挽救性食管切除术。所有患者均接受超过60戈伊的放疗，同时接受化疗以达到治愈目的。结果：与未行术前治疗的食管切除术患者相比，行挽救性食管切除术的患者术后并发症和死亡率增加（平均住院时间，38 vs 33天;吻合口瘘发生率，31% vs 25%;呼吸系统并发症发生率，31% vs 20%; 1周内再次插管，2% vs 2%;住院死亡率，8%对2%）。气管支气管坏死和胃导管坏死是抢救性食管切除术后的高致死性并发症; 3年术后生存率分别为38%和58%，respectively.Conclusion：患者接受明确的高剂量放化疗后抢救性食管切除术的发病率和死亡率增加。然而，考虑到挽救性食管切除术后的潜在长期生存率，这是可以接受的。这种治疗应考虑在专业中心精心挑选的患者。
Objective: Chemoradiotherapy is a popular definitive therapy for esophageal carcinoma among many patients and oncologists. Although the complete response rates are high and short-termsurvival is favorable after chemoradiotherapy, persistent or recurrent locoregional disease is frequent. Salvage surgery is the sole curative intent treatment option for this course of the disease. The present study evaluates the safety and value of salvage esophagectomy for locoregional failure after high-dose definitive chemoradiotherapy for esophageal squamous cell carcinoma.Methods: We reviewed 59 consecutive patients with thoracic esophageal squamous cell carcinoma who underwent salvage esophagectomy after definitive chemoradiotherapy. All patients received more than 60 Gy of radiation plus concurrent chemotherapy for curative intent. The data were compared with those of patients who received esophagectomy without preoperative therapy.Results: Postoperative morbidity and mortality rates were increased among patients who underwent salvage esophagectomy compared with those who underwent esophagectomy without preoperative therapy (mean hospital stay, 38 vs 33 days; anastomotic leak rates, 31% vs 25%; respiratory complication rates, 31% vs 20%; re-intubation within 1 week, 2% vs 2%; hospital mortality rates, 8% vs 2%). Tracheobronchial necrosis and gastric conduit necrosis were highly lethal complications after salvage esophagectomy; 3-year postoperative survivals were 38% and 58%, respectively.Conclusion: Patients who underwent salvage esophagectomy after definitive high-dose chemoradiotherapy had increased morbidity and mortality. Nevertheless, this is acceptable in view of the potential long-term survival after salvage esophagectomy. Such treatment should be considered for carefully selected patients at specialized centers.