食管癌根治性放化疗局部失败后挽救性手术的安全性和疗效

A retrospective study on salvage surgery after local failure of definitive chemoradiotherapy for esophageal carcinomas

目的 研究根治性放化疗局部未控或复发后进行挽救性手术的安全性和疗效.方法 采用回顾性调查方法,收集河南省人民医院2008年7月至2010年6月根治性放化疗局部失败后进行挽救性手术和非手术治疗的cT1-3 N0-1M0病例共37例,观察手术成功率、并发症发生率和近期生存率.结果 26例进行了挽救性手术,11例给予化疗等非手术治疗.挽救性手术切除率84.6％（22/26）,完全性切除率69.2％（18/26）.无围手术期死亡病例.并发症发生率为53.8％（14/26）,其中肺部感染8例（30.8％）,吻合口瘘3例（11.5％）,心率失常2例（7.7％）,喉返神经损伤l例（3.8％）.中位生存期11.1个月,2年生存率23.1％.非手术治疗组中位生存期8.1（3.1～15.1）个月.挽救性手术组生存期长于非手术治疗组（Kaplan-Meier方法,x2=6.14,P=0.013）.结论 根治性放化疗后局部未控或复发的病例,挽救性手术较非手术治疗可以有效延长生存期,鉴于术后并发症发生率较高,术前应严格评估身体状态和病变的完全性切除可能性.

Objective To evaluate the feasibility and efficacy of salvage surgery after local failure of definitive chemoradiotherapy （dCRT） for esophageal carcinomas.Methods We retrospectively reviewed the esophageal cancer patients underwent salvage surgery （Group A,26 cases） or non-surgical therapy （Group B,11 cases） after local failure of dCRT（cT1-3 N0 1 M0） between July 2008 and June 2010.Results The rate of resection was 84.6% in Group A,R0 was 69.2%.There was no mortality after surgery.The rate of postoperative complications is 53.8%,especially pneumonia 30.8%,anastomosis leakage11.5% and arrhythmia 7.7%.The median survival time is 11.1 months; the 2-year survival rate of Group A was 23.1% in Group A.The non-surgical therapy was given including second-line chemotherapy and esophagus stents;the median survival time is 8.1 months （3.1-15.1） in Group B.The survival rate of Group A was higher than Group B （Kaplan-Meier,P =0.013）.Conclusion Salvage surgery provides survival benefit for esophageal cancer patients with local persistent or recurrence after primary dCRT,despite of high morbidity.Salvage surgery should be carried out for patients with good physical condition and complete resection is technically possible.