Wang Wen-guang, Li Jin-dong, Qi Jin-xing, Luo Rui-hua, Gao Zong-ren, Shao Ling-fang
Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2008 Jan;11(1):19-23.
To summarize the experience of surgical treatment for cervical esophageal carcinoma.
Clinical and follow-up data of 82 patients with cervical esophageal carcinoma undergone surgical treatment in Henan Provincial Cancer Hospital from Dec. 1993 to Dec. 2005 were analyzed retrospectively. The difference of the therapeutic regimen and 5-year survival rate of these patients were evaluated.
Before 1997, patients mainly underwent surgical therapy solely (27 cases). After 1997, 50 cases received surgical therapy following neoadjuvant radiotherapy (multimodality group), except 5 early-stage cases received surgical therapy solely. Seventy-three patients underwent esophagectomy without thoracotomy, including 21 cases of invert-stripping of the esophagus, and 52 cases of blunt denudation of esophagus. Nine patients underwent transthoracic esophagectomy. Concurrent monolateral or bilateral cervical lymph node dissection accounted for 14 cases and combined organ resection 12 cases. No serious hemorrhage and tracheal or bronchial tearing occurred. No hospital death occurred. Postoperative complications were found in 14 patients, and the incidence of complication was 19.5%. In sole surgery group, upper incised margins of 5 patients were confirmed to be positive. The laryngeal function of 26 patients in sole surgery group was preserved, while 47 patients in multimodality group preserved. Lymph node metastasis occurred in 14 cases, including 13 cases cervical lymph node metastasis (monolateral 9, bilateral 4) and 1 case of upper mediastinal lymph node metastasis. During follow-up, 3 patients were lost. The total 5-year survival rate was 43%. The patients in multimodality group had higher 5-year survival rate as compared to those in sole surgery group. (50.2% vs 33.9%,chi(2 )=7.17,P=0.007). The 5-year survival rates of patients with transthoracic esophagectomy, esophagectomy plus concurrent monolateral or bilateral cervical lymph nodes dissection or combined organ resection were 36.5%, 45.8% and 33.3% respectively. All the 5-year survival rates of these subgroups were lower as compared to multimodality group.
For patients with early stage cervical esophageal carcinoma and with proximal end of residual normal esophagus longer than 2 cm, the optimal therapy should be surgery. For most of the patients, surgery combined with neoadjuvant radiotherapy is the ideal therapeutic strategy, which can lower the risk of positive revised margin, improve the possibility of preserving the laryngeal function and result in the improvement of 5-year survival rate. Esophagectomy without thoracotomy should be preferred. Combined organ resection or bilateral lymph node dissection should be chosen carefully because these operating procedures may lead to severe injury and function lose.
总结颈段食管癌的外科治疗经验。
回顾性分析1993年12月至2005年12月在河南省肿瘤医院接受手术治疗的82例颈段食管癌患者的临床及随访资料。评估这些患者治疗方案及5年生存率的差异。
1997年前，患者主要单纯接受手术治疗（27例）。1997年后，50例患者在新辅助放疗后接受手术治疗（多模式组），另有5例早期患者单纯接受手术治疗。73例患者行非开胸食管切除术，其中食管内翻拔脱术21例，食管钝性剥离术52例。9例患者行开胸食管切除术。同期行单侧或双侧颈淋巴结清扫术14例，联合器官切除术12例。未发生严重出血及气管或支气管撕裂。无医院死亡病例。14例患者出现术后并发症，并发症发生率为19.5%。单纯手术组5例患者上切缘病理证实为阳性。单纯手术组26例患者保留喉功能，多模式组47例患者保留喉功能。发生淋巴结转移14例，其中颈部淋巴结转移13例（单侧9例，双侧4例），上纵隔淋巴结转移1例。随访期间，3例患者失访。总5年生存率为43%。多模式组患者的5年生存率高于单纯手术组。（50.2%对33.9%，χ²=7.17，P=0.007）。开胸食管切除术、食管切除术加同期单侧或双侧颈淋巴结清扫术或联合器官切除术患者的5年生存率分别为36.5%、45.8%和33.3%。这些亚组的所有5年生存率均低于多模式组。
对于颈段早期食管癌且残余正常食管近端长度大于2 cm的患者，最佳治疗方法应为手术。对于大多数患者，手术联合新辅助放疗是理想的治疗策略，可降低切缘阳性风险，提高保留喉功能的可能性，并提高5年生存率。应首选非开胸食管切除术。联合器官切除术或双侧淋巴结清扫术应谨慎选择，因为这些手术操作可能导致严重损伤和功能丧失。
