Factors Influencing the Long-Term Survival in Patients with Esophageal Cancer Who Underwent Esophagectomy After Chemoradiotherapy
Factors Influencing the Long-Term Survival in Patients with Esophageal Cancer Who Underwent Esophagectomy After Chemoradiotherapy
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DOI：
10.1007/s00268-009-0331-9
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发表时间：
2010-02-01
影响因子：
2.6
通讯作者：
Kitagawa, Yuko
中科院分区：
文献类型：
--
作者：
Takeuchi, Hiroya;Saikawa, Yoshiro;Kitagawa, Yuko
挽救性食管切除术可能是唯一可用的治疗方法，可以提供长期生存的机会时，明确的放化疗（CRT）未能实现局部控制食管鳞状细胞癌（ESCC）患者。然而，与新辅助放化疗（CRT）后计划的食管切除术相比，挽救性食管切除术是一种高度侵入性手术，具有各种术后并发症。我们假设严重的术后并发症不仅会影响手术死亡率，还可能影响CRT后挽救性食管切除术患者的肿瘤复发和长期生存率。在本研究中，我们回顾了65例连续的胸段食管鳞癌患者在新辅助化疗后接受食管切除术的手术方法、术后并发症和预后。新辅助治疗组40例，保留治疗组25例，均行右胸扩大食管癌切除，经皮下胃导管重建，左颈部吻合。挽救治疗组术后肺炎的发生率高于新辅助治疗组。在两组中，R 0切除患者的生存率明显优于R1/R2切除患者。此外，在挽救组中，肺炎或菌血症/脓毒症患者的术后生存率显著低于未发生相同并发症的患者。在新辅助治疗组中，在单因素和多因素分析中，R 0切除被选为唯一的独立预后因素。相比之下，在挽救组中，R 0切除术和菌血症/脓毒症仍然显着，并独立于其他因素在多变量analysis.This研究表明，术后发病率不仅影响围手术期死亡率，但也与食管鳞癌患者接受挽救性食管切除术后明确CRT的长期生存。
Salvage esophagectomy is potentially the only treatment available that can offer a chance of long-term survival when definitive chemoradiotherapy (CRT) fails to achieve local control for patients with esophageal squamous cell carcinoma (ESCC). However, salvage esophagectomy is a highly invasive procedure with various postoperative complications compared to planned esophagectomy after neoadjuvant chemoradiotherapy (CRT). We hypothesize that severe postoperative complications may affect not only surgical mortality but also tumor recurrence and long-term survival for patients with salvage esophagectomy after definitive CRT.For the present study we reviewed the surgical procedures, postoperative complications, and the prognosis of 65 consecutive patients with thoracic ESCC who underwent the esophagectomy after neoadjuvant (neoadjuvant group: n = 40) or definitive (salvage group: n = 25) CRT.Most patients underwent right-transthoracic extended esophagectomy and reconstruction using gastric conduit by way of subcutaneous route with left cervical anastomosis. The incidence of postoperative pneumonia was found to be higher in the salvage group than in the neoadjuvant group. In both groups, the survival of patients with R0 resection was significantly better than those with R1/R2 resection. Moreover, in the salvage group, the postoperative survival rate of patients with pneumonia or bacteremia/sepsis was significantly lower than that for patients who did not suffer the same complications. In the neoadjuvant group, R0 resection was selected to be the only independent prognostic factor in univariate and multivariate analysis. In contrast, in the salvage group, R0 resection and bacteremia/sepsis remained significant and were independent of the other factors in multivariate analysis.This study reveals that postoperative morbidity affects not only the perioperative mortality but also the long-term survival of patients with ESCC who undergo salvage esophagectomy after definitive CRT.