食管鳞癌全量放化疗后复发补救手术患者的生存期分析

Salvage esophagectomy for recurrent esophageal squamous cell carcinoma treated with definitive chemo-radiotherapy: long-term survival analysis

目的评价食管鳞癌全量放化疗后复发补救性食管切除手术的临床价值及安全性,并分析影响预后的因素。方法收集58例食管鳞癌根治性放化疗后复发补救性食管切除手术患者的临床资料,回顾性分析手术方式、术后并发症、术后pTNM分期等参数对预后的影响。结果 58例患者均予右胸入路,经后纵隔食管床胃代食管重建消化道,行颈胸腹三切口颈部吻合术式43例,胸腹二切口胸内吻合15例。R0切除50例,R1切除8例。术后并发症发生率和住院死亡率分别为22.4%和3.4%。术后中位总生存期为59.9个月,5年生存率为49.3%。单因素及多因素分析显示,术后pT、pN分期为影响术后远期生存的危险因素。结论食管鳞癌全量放化疗后复发予以补救性食管切除手术的风险较高,但可延长生存。术后pT分期、pN分期可以为术后的生存预测提供参考。

Objective To evaluate the safety and value of salvage esophagectomy for locoregional recurrence after definitive chemo-radiotherapy for esophageal squamous cell carcinoma,and to explore the prognostic factors affecting long-term survival. Methods Fifty-eight consecutive patients with esophageal squamous cell carcinoma submitted to salvage esophagectomy for locoregional recurrent disease after primary exclusive chemoradiotherapy were retrospectively analyzed.The surgical procedures,postoperative complications,postoperative TNM staging,overall survival and the prognosis were reviewed. Results All the patients received right-transthoracic esophagectomy and reconstruction using gastric conduit by way of posterior-mediastinal route,with 3-field left cervical anastomosis（43 cases） or 2-field intra-thoracic anastomosis（15 cases）.R0 resection was achieved in 50 cases,while R1 resection in 8 cases.Overall postoperative morbidity and mortality were 22.4% and 3.4%,respectively.The median survival was 59.9 months with a 5-year overall survival rate of 49.3%.Postoperative pathological T stage and N stage were independent prognostic factors in univariate and multivariate analysis. Conclusion Although associated with increased morbidity and mortality,salvage esophagectomy provides long-term survival benefit in esophageal squamous cell carcinoma patients with locoregional recurrent disease after primary definitive chemo-radiotherapy.Postoperative pathological T stage and N stage seem to be valuable for prognostic evaluation.