食管癌术后局限性颈部/上纵隔淋巴结转移再手术效果探讨

Evaluation of Reoperation Value of Local Cervical or Upper Mediastinal Lymph Node Recurrence after Esophageal Cancer Surgery

目的探讨食管癌术后颈部或上纵隔淋巴结转移再手术的治疗效果。方法前瞻性收集2019年1月至2022年9月在安阳市肿瘤医院胸外科复查的食管癌术后患者,发现颈部或上纵隔淋巴结转移,CT显示无外侵,可以手术切除的患者,共31例。根据患者的意愿分为观察组和对照组。观察组16例选择再手术治疗,术后辅助或不辅助放化疗;对照组15例选择单纯放化疗。对比两组的基线资料、随访生存情况,主要研究终点为局部复发和区域复发。结果两组患者的基线数据比较无明显差异,观察组出现2例颈部淋巴瘘,2例喉返神经损伤,1个月后声音嘶哑均恢复正常。手术时间平均为43 min,术后平均住院时间5.8 d,平均住院花费15042元。观察组1 a生存率100%,局部控制率为80%。对照组无治疗后并发症,1 a生存率93.3%,局部控制率为46.7%,相对危险度(relative risk,RR)为0.5,归因危险度(attributable risk,AR)为0.46,对照组平均住院时间为45 d,平均住院花费为42352元。两组比较显示:观察组1 a局部控制率显著优于对照组,以局部复发为研究终点,绘制Kaplan-Meier生存曲线,观察组显著优于对照组(P=0.048)。结论对于食管癌术后局限性颈部/上纵隔淋巴结转移的患者,再手术治疗安全、创伤小、花费低、局部控制率高。

Objective To investigate the reoperation value of cervical or upper mediastinal lymph node recurrence after esophageal cancer surgery.Methods Prospective collection of 31 postoperative patients with esophageal cancer who underwent reexamination in our department from January 2019 to September 2022,were found to have lymph node metastasis in the neck or upper mediastinum,and CT scan showed no external invasion and could be surgically removed.According to the patient’s wishes.16 cases in the observation group were selected for reoperation treatment,with or without adjuvant radiotherapy and chemotherapy after surgery;15 cases in the control group were selected for simple radiotherapy and chemotherapy.Comparing the baseline data and follow-up survival between the two groups,the main endpoint of the study was local recurrence and regional recurrence.Results There was no significant difference in baseline data between the two groups of patients.The observation group had 2 cases of cervical lymphatic fistula and 2 cases of recurrent laryngeal nerve injury.Hoarseness returned to normal one month later.The average surgical time is 43 minutes,the average postoperative hospitalization time is 5.8 days,and the average hospitalization cost is 15042 yuan.The survival rate of observation group 1-year was 100%,and the local control rate was 80%.The control group had no postoperative complications,a 1-year survival rate of 93.3%,a local control rate of 46.7%,a relative risk(RR)of 0.5,and an attributed risk(AR)of 0.46.The average length of hospital stay in the control group was 45 days,and the average hospitalization cost was 42352 yuan.Comparison between two groups showed that the local control rate of observation group 1a was significantly better than that of the control group.Using local recurrence as the study endpoint,Kaplan Meier survival curve was plotted,and the observation group was significantly better than the control group(P=0.048).Conclusion For cervical or upper mediastinal lymph node metastasisafter esophageal cancer surgery,reoperation is safe,reliable,low cost and high local control rate.