Rizzetto C, DeMeester S R, Hagen J A, Peyre C G, Lipham J C, DeMeester T R
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
J Thorac Cardiovasc Surg. 2008 Jun;135(6):1228-36. doi: 10.1016/j.jtcvs.2007.10.082. Epub 2008 May 23.
Neoadjuvant therapy is commonly used for esophageal adenocarcinoma. We have reported reduced local recurrence rates and improved survival after an en bloc esophagectomy compared with a transhiatal resection as primary therapy for adenocarcinoma of the esophagus. The aim of this study was to determine whether the benefits of an en bloc resection would extend to patients after neoadjuvant therapy.
The charts of all patients with esophageal adenocarcinoma that had neoadjuvant therapy and en bloc or transhiatal esophagectomy from 1992-2005 were reviewed. Patients found to have systemic metastatic disease at the time of the operation or who had an incomplete resection were excluded.
There were 58 patients: 40 had an en bloc resection and 18 had a transhiatal esophagectomy. A complete pathologic response occurred in 17 (29.3%) of 58 patients. Median follow-up was 34.1 months after en bloc resection and 18.3 months after transhiatal resection (P = .18). Overall survival at 5 years and survival in patients with residual disease after neoadjuvant therapy was significantly better with an en bloc resection (overall survival: 51% for en bloc resection and 22% for transhiatal resection [P = .04]; survival with residual disease: 48% for en bloc resection and 9% for transhiatal resection [P = .02]). Survival in patients with complete pathologic response tended to be better after an en bloc resection (en bloc, 70%; transhiatal, 43%; P = .3).
An en bloc resection provides a survival advantage to patients after neoadjuvant therapy compared with a transhiatal resection, particularly for those with residual disease. Similar to patients treated with primary resection, an en bloc esophagectomy is the procedure of choice after neoadjuvant therapy.
新辅助治疗常用于食管腺癌。我们曾报道，与经胸食管切除术相比，整块食管切除术作为食管腺癌的主要治疗方法可降低局部复发率并提高生存率。本研究的目的是确定整块切除术的益处是否会扩展到接受新辅助治疗后的患者。
回顾了1992年至2005年期间所有接受新辅助治疗并接受整块或经胸食管切除术的食管腺癌患者的病历。排除手术时发现有全身转移性疾病或切除不完全的患者。
共有58例患者：40例行整块切除术，18例行经胸食管切除术。58例患者中有17例（29.3%）出现完全病理缓解。整块切除术后的中位随访时间为34.1个月，经胸切除术后为18.3个月（P = 0.18）。整块切除术的5年总生存率和新辅助治疗后有残留疾病患者的生存率明显更高（总生存率：整块切除术为51%，经胸切除术为22% [P = 0.04]；有残留疾病患者的生存率：整块切除术为48%，经胸切除术为9% [P = 0.02]）。整块切除术后完全病理缓解患者的生存率倾向于更高（整块切除，70%；经胸切除，43%；P = 0.3）。
与经胸切除术相比，整块切除术为新辅助治疗后的患者提供了生存优势，特别是对于那些有残留疾病的患者。与接受初次切除术的患者类似，整块食管切除术是新辅助治疗后的首选手术方式。
