Tachimori Yuji
Esophageal Surgery Division, Department of Surgery, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo 104-0045, Japan.
Gen Thorac Cardiovasc Surg. 2009 Feb;57(2):71-8. doi: 10.1007/s11748-008-0337-5. Epub 2009 Feb 12.
Chemoradiotherapy has become a popular definitive therapy among many patients and oncologists for potentially resectable esophageal carcinoma. Although the complete response rates are high and short-term survival is favorable after chemoradiotherapy, persistent or recurrent locoregional disease is quite frequent. Salvage surgery is the sole curative intent treatment option for this course. As experience with definitive chemoradiotherapy grows, the number of salvage surgeries may increase. Selected articles about salvage esophagectomy after definitive chemoradiotherapy for esophageal carcinoma are reviewed. The number of salvage surgeries was significantly lower than the number of expected candidates. To identify candidates for salvage surgery, patients undergoing definitive chemoradiotherapy should be followed up carefully. Salvage esophagectomy is difficult when dissecting fibrotic masses from irradiated tissues. Patients who underwent salvage esophagectomy had increased morbidity and mortality. Pulmonary complications such as pneumonia and acute respiratory distress syndrome were common. The anastomotic leak rate was significantly increased because of the effects of the radiation administered to the tissues used as conduits. The most significant factor associated with long-term survival appeared to be complete resection. However, precise evaluation of resectability before operation was difficult. Nevertheless, increased morbidity and mortality will be acceptable in exchange for potential long-term survival after salvage esophagectomy. Such treatment should be considered for carefully selected patients at specialized centers.
对于潜在可切除的食管癌患者，放化疗已成为许多患者和肿瘤学家常用的确定性治疗方法。尽管放化疗后的完全缓解率较高且短期生存率良好，但局部区域疾病的持续或复发却相当常见。挽救性手术是针对此病程的唯一具有治愈意图的治疗选择。随着确定性放化疗经验的增加，挽救性手术的数量可能会增加。本文回顾了有关食管癌确定性放化疗后挽救性食管切除术的相关文献。挽救性手术的数量明显低于预期候选者的数量。为了确定挽救性手术的候选者，应对接受确定性放化疗的患者进行仔细随访。从受照射组织中分离纤维化肿块时，挽救性食管切除术难度较大。接受挽救性食管切除术的患者发病率和死亡率增加。肺部并发症如肺炎和急性呼吸窘迫综合征很常见。由于对用作管道的组织进行放疗的影响，吻合口漏率显著增加。与长期生存相关的最重要因素似乎是完全切除。然而，术前对可切除性进行精确评估很困难。尽管如此，为了挽救性食管切除术后潜在的长期生存，增加的发病率和死亡率是可以接受的。对于在专业中心经过精心挑选的患者，应考虑这种治疗方法。
