Advances in esophageal cancer surgery in Japan: An analysis of 1000 consecutive patients treated at a single institute
Advances in esophageal cancer surgery in Japan: An analysis of 1000 consecutive patients treated at a single institute
复制标题
DOI：
10.1016/j.surg.2007.12.007
复制
发表时间：
2008-04-01
期刊：
影响因子：
3.8
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Morita, Masaru;Yoshida, Rintaro;Maehara, Yoshihiko
背景。在日本，大多数食管癌为鳞状细胞癌，近年来食管癌切除术的效果有显著改善。本研究的目的是评价日本食管癌手术治疗的进展。我们评估了日本一家机构连续1000例食管癌患者的死亡率、发病率和预后。根据食管切除术时间将患者分为3组：第一组（197例），1964 ~ 1980年；II组（n = 432）， 1981-1993年；III组（n = 371）， 1993-2006年。鳞状细胞癌的发生率为94%。ⅰ组、ⅱ组和ⅲ组的发病率分别为62%、38%和33% （P < 0.01，ⅰ组与ⅱ组和ⅲ组比较），住院死亡率分别为14.2%、5.1%和2.4% （P < 0.01）。5年总生存率为30% （I、II、III组分别为14%、27%、46%，P < 0.0001）。多因素分析显示，年龄、性别、浸润深度、淋巴结转移、远处转移、治愈率、淋巴结切除程度、可切除性和手术时间是影响预后的独立因素。一般来说，食管切除术是安全的，没有严重的并发症；然而，随着手术技术和治疗方式的进步，预后有了显著改善。
Background. In Japan, most esophageal cancers are squamous cell carcinomas, and the results Of esophagectomy have improved remarkably in recent years. The object of this study was to evaluate advances in operative therapy for esophogeal cancer in Japan.Method. We evaluated mortality, morbidity, and prognosis in 1000 consecutive patients who underwent esophagectomy for esophageal cancer at a single institution in Japan. The patients were divided into 3 groups according to the period when esophagectomy was performed: Group I (n = 197), 1964-1980; group II (n = 432), 1981-1993; and group III (n = 371), 1993-2006.Results. The incidence of squamous cell carcinoma was 94%. The morbidity rates were 62%, 38 and 33%, in groups I, II, and III, respectively (P < 0.01, groups I vs II and III), and the in-hospital mortality rates were 14.2%, 5.1%, and 2.4%, respectively (P < 0.01, between each group). The 5-year overall survival rate was 30% (14%, 27%, and 46% in groups I, II, and III, respectively; P < 0.0001.). Multivariate analysis revealed age, gender, depth of invasion, node metastasis, distant metastasis, curability, extent of lymphadenectomy, resectability, and the period when the operation was performed as independent prognostic factors.Conclusion. Generally, esophagectomy has been performed safely without critical complications; however, the prognosis has improved remarkably with advances in surgical techniques and treatment modalities.