颈段食管癌施行保留咽和喉手术为主的综合治疗远期疗效

Outcome after surgery preserving pharynx and larynx for cervical esophageal cancer

目的探讨以胸外科为主的多学科综合治疗对颈段食管癌的远期疗效。方法回顾性分析北京大学肿瘤医院胸外科单一手术组2000年3月至2011年3月间施行以胸外科保留咽、喉手术为主的多学科综合治疗的41例颈段食管癌患者的临床及随访资料．并与同期同一手术组治疗的480例非颈段食管癌进行比较。结果41例颈段食管癌患者中男28例，女13例，平均年龄62岁。接受术前化疗30例．术后化疗25例，手术前后均予以化疗21例，术后放疗6例。除4例仅行探查手术外，另37例行食管癌根治性切除颈部吻合，其中1例围手术期死亡。接受根治性切除术并顺利出院的36颈段食管癌患者术后1、3、5和8年累计生存率分别为96．8％、52．6％、35．1％和35．1％：而同期接受根治性切除术并顺利出院的457例非颈段食管癌患者的1年、3年、5年和8年累计生存率分别为85．0％、54．3％、45．0％和36．7％；两组差异无统计学意义（19〉0．05）。结论以胸外科为主的多学科综合治疗颈段食管癌能够获得较为满意的远期疗效。

Objective To evaluate the long-term survival of multidisciplinary treatment based on thoracic surgery for cervical esophageal squamous cell carcinoma. Methods The clinical characters and follow-up data of forty-one cervical esophageal cancer patients who accepted muhidisciplinary treatment based on surgery with preservation of pharynx and larynx were retrospectively reviewed, and the long-term survival was compared with 480 non-cervical esophageal cancers who accepted surgery in the same period done by the same surgical team. Results There were 28 males and 13 females with a mean age of 62 years old. In the cervical esophageal cancer group, 30 patients accepted neoadjuvant chemotherapy, 25 patients accepted adjuvant chemotherapy, and 21 patients accepted both. Six patients received postoperative radiation. Four patients underwent exploratory surgery alone, and 37 eases underwent radical surgery and cervical anastomosis. One case died during the perioperative period. The 1-, 3-, 5- and 8-year survival rates were 96.8%, 52.6%, 35.1%, and 35.1% in the 36 patients with cervical esophageal cancer who underwent radical surgery, and were 85.0%, 54.3%, 45.0% , and 36.7% respectively in the 457 non-cervical esophageal cancer patients. There was no significant difference between the cervical group and non-cervical group （P=0.91）. ConclusionCervical esophageal cancer should be treated in a multidisciplinary approach to obtain satisfactory long- term outcomes.