Visbal A L, Allen M S, Miller D L, Deschamps C, Trastek V F, Pairolero P C
Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2001 Jun;71(6):1803-8. doi: 10.1016/s0003-4975(01)02601-7.
To examine the efficacy of the Ivor Lewis esophagogastrectomy for esophageal carcinoma prior to the widespread use of preoperative chemotherapy and irradiation, we reviewed our experience.
We reexamined the cases of 220 consecutive patients who underwent an Ivor Lewis esophagogastrectomy for esophageal cancer from January 1992 through December 1995.
There were 196 men (89.1%) and 24 women. Median age was 65 years (range, 29 to 85 years). The results of pathological study showed adenocarcinoma in 188 patients (85.5%), squamous cell carcinoma in 31 (14.1%), and leiomyosarcoma in 1 patient (0.5%). Postsurgical staging was as follows: stage 0 in 10 patients, stage I in 19, stage IIa in 38, stage IIb in 28, stage III in 111, and stage IV in 14. The operative mortality rate was 1.4% (3 patients), and complications occurred in 83 patients (37.7%). Follow-up was 98.6% complete. Median survival for operative survivors was 1.9 years (range, 32 days to 8.7 years). The overall 5-year survival rate was 25.2%; it was 80% for patients in stage 0, 94.4% for those in stage I, 36.0% for those in stage IIa, 14.3% for patients in stage IIb, 10% for those in stage III and 0% for patients in stage IV.
Ivor Lewis esophagogastrectomy for esophageal cancer is a safe operation. Long-term survival is stage dependent. The low survival associated with advanced cancers should stimulate the search for effective neoadjuvant therapy.
为了在术前化疗和放疗广泛应用之前检验艾弗·刘易斯食管胃切除术治疗食管癌的疗效，我们回顾了我们的经验。
我们重新审视了1992年1月至1995年12月期间连续接受艾弗·刘易斯食管胃切除术治疗食管癌的220例患者的病例。
男性196例（89.1%），女性24例。中位年龄为65岁（范围29至85岁）。病理研究结果显示，腺癌188例（85.5%），鳞状细胞癌31例（14.1%），平滑肌肉瘤1例（0.5%）。术后分期如下：0期10例，Ⅰ期19例，Ⅱa期38例，Ⅱb期28例，Ⅲ期111例，Ⅳ期14例。手术死亡率为1.4%（3例患者），83例患者（37.7%）出现并发症。随访完成率为98.6%。手术幸存者的中位生存期为1.9年（范围32天至8.7年）。总体5年生存率为25.2%；0期患者为80%，Ⅰ期患者为94.4%，Ⅱa期患者为36.0%，Ⅱb期患者为14.3%，Ⅲ期患者为10% , Ⅳ期患者为0%。
艾弗·刘易斯食管胃切除术治疗食管癌是一种安全的手术。长期生存取决于分期。与晚期癌症相关的低生存率应促使人们寻找有效的新辅助治疗方法。
