Wilson Kenneth S, Wilson Amanda G, Dewar Gary J
Vancouver Island Cancer Centre, 2410 Lee Avenue, Victoria, British Columbia V8R 6V5, Canada.
Can J Gastroenterol. 2002 Jun;16(6):361-8. doi: 10.1155/2002/767602.
To review outcomes after curative treatment for esophageal cancer in the Vancouver Island Cancer Centre from 1993 to 1998. Curative treatments included esophagectomy alone, and chemoradiotherapy with "selective surgery" for patients with post-treatment-positive endoscopic biopsy or less than 75% regression on computed axial tomography scan, or with resectable local recurrence.
Patients undergoing esophagectomy alone, or primary chemoradiotherapy and "selective surgery" were reviewed. This was a retrospective, nonrandomized, institutional experience. Surgical complication, relief of dysphagia, disease-specific survival rates and prognostic factors were analyzed.
Nineteen patients underwent esophagectomy alone. A total of 56 patients underwent primary chemoradiotherapy, of whom 16 had "selective surgery". Relief of dysphagia was similar in both groups of esophagectomy patients. Exploration for "selective surgery" was performed in 12 patients after their first postchemo-radiotherapy endoscopy (two patients had unresectable disease), and in seven for relapse, one of whom died intraoperatively. Overall, the mortality rate due to surgery was 3%. Chemoradiotherapy was not associated with more frequent serious surgical complications. For patients who underwent esophagectomy alone and those who underwent chemoradiotherapy plus selective surgery, the median survival times were 12.9 and 16.4 months, respectively, and the three-year survival rates were 21% and 37%, respectively. Seventeen of 25 patients who underwent chemoradiotherapy and who survived more than two years have not required selective surgery. For the two groups of patients combined, no single prognostic factor for survival was significant in multivariate analysis, but for patients who underwent chemoradiotherapy plus selective surgery, negative endoscopic biopsy was highly significant.
Surgical complication and disease-specific survival rates after primary chemoradiotherapy with selective surgery compare favourably with esophagectomy alone in the curative treatment of esophageal cancer. A prospective, randomized trial is necessary for the definitive evaluation of the strategy of chemoradiotherapy and selective surgery.
回顾1993年至1998年温哥华岛癌症中心食管癌根治性治疗后的结果。根治性治疗包括单纯食管切除术，以及对内镜活检后呈阳性或计算机断层扫描显示消退少于75%的患者，或局部复发可切除的患者进行放化疗并“选择性手术”。
对接受单纯食管切除术或初始放化疗及“选择性手术”的患者进行回顾。这是一项回顾性、非随机的机构性经验研究。分析手术并发症、吞咽困难缓解情况、疾病特异性生存率和预后因素。
19例患者接受了单纯食管切除术。共有56例患者接受了初始放化疗，其中16例进行了“选择性手术”。两组食管切除术患者的吞咽困难缓解情况相似。12例患者在首次放化疗后内镜检查后进行了“选择性手术”探查（2例患者疾病无法切除），7例因复发进行探查其中1例术中死亡。总体而言手术死亡率为3%。放化疗与更频繁的严重手术并发症无关。接受单纯食管切除术的患者和接受放化疗加选择性手术的患者，中位生存时间分别为12.9个月和16.4个月三年生存率分别为21%和37%。接受放化疗且存活超过两年的25例患者中有17例无需进行选择性手术。对于两组合并的患者多因素分析中没有单一生存预后因素具有显著性，但对于接受放化疗加选择性手术的患者内镜活检阴性具有高度显著性。
在食管癌根治性治疗中，初始放化疗加选择性手术的手术并发症和疾病特异性生存率与单纯食管切除术相比具有优势。需要进行一项前瞻性随机试验以明确评估放化疗和选择性手术策略。
