Chao Y K, Chan S C, Chang H K, Liu Y H, Wu Y C, Hsieh M J, Tseng C K, Liu H P
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Eur J Surg Oncol. 2009 Mar;35(3):289-94. doi: 10.1016/j.ejso.2008.02.014. Epub 2008 Apr 8.
To investigate the survival benefit and preoperative risk factors for hospital mortality of salvage surgery in esophageal cancer patients who had locoregional residual/recurrent tumor after definitive chemoradiotherapy.
We retrospectively reviewed the esophageal cancer patients who presented at our hospital from 1997 to 2004. Forty-seven patients who had squamous cell cancer and developed locoregional recurrent/persistent disease after primary definitive chemoradiotherapy were elected. Twenty-seven of them received salvage esophagectomy (group 1) and the other 20 underwent non-operative treatment only (group 2). In order to assess the surgery-related mobility and mortality in group 1, 191 patients who received neoadjuvant chemoradiotherapy followed by operation during the same time period were also enrolled (group 3).
The 5-year overall survival of group 1 patients was 25.4%. In contrast, all of the patients in the group 2 died within 16.7 months. The difference was statistically significant (p=0.0029). In comparison with group 3, group 1 patients had significantly more surgery-related complications and hospital mortality. In univariate analysis for preoperative risk factors, a low albumin or hemoglobulin level was associated with high hospital mortality in group 1 (p=0.004 and 0.003, respectively). After multivariate analysis, only the low albumin level remained borderline significance. As for disease specific survival after salvage surgery, R0 resection was the only independent prognosticator (p=0.049).
Salvage surgery provides survival benefit in esophageal cancer patients with locoregional persistent or recurrent disease after primary definitive chemoradiotherapy. Preoperative albumin and hemoglobulin levels are associated with hospital mortality and may aid in selecting suitable patient for salvage surgery.
探讨接受根治性放化疗后出现局部区域残留/复发肿瘤的食管癌患者行挽救性手术的生存获益及术前医院死亡风险因素。
我们回顾性分析了1997年至2004年在我院就诊的食管癌患者。选取47例鳞状细胞癌患者，这些患者在初次根治性放化疗后出现局部区域复发/持续性疾病。其中27例接受了挽救性食管切除术（第1组），另外20例仅接受非手术治疗（第2组）。为了评估第1组与手术相关的活动能力和死亡率，还纳入了同期接受新辅助放化疗后行手术的191例患者（第3组）。
第1组患者的5年总生存率为25.4%。相比之下，第2组所有患者均在16.7个月内死亡。差异具有统计学意义（p = 0.0029）。与第3组相比，第1组患者手术相关并发症和医院死亡率显著更高。在术前风险因素的单因素分析中，低白蛋白或血红蛋白水平与第1组的高医院死亡率相关（分别为p = 0.004和0.003）。多因素分析后，仅低白蛋白水平仍具有临界显著性。至于挽救性手术后的疾病特异性生存，R0切除是唯一的独立预后因素（p = 0.049）。
挽救性手术为初次根治性放化疗后出现局部区域持续性或复发性疾病的食管癌患者提供生存获益。术前白蛋白和血红蛋白水平与医院死亡率相关，可能有助于选择适合挽救性手术的患者。
