Boonstra J J, Koppert L B, Wijnhoven B P, Tilanus H W, Van Dekken H, Tran T C K, Van der Gaast A
Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
J Surg Oncol. 2009 Oct 1;100(5):407-13. doi: 10.1002/jso.21358.
Patients with carcinoma of the distal esophagus and metastatic celiac lymph nodes (M1a) have a poor prognosis and are often denied surgery. In this study, we evaluated our treatment strategy of chemotherapy followed by surgery in patients with M1a disease.
Thirty-eight patients who received chemotherapy for carcinoma of the distal esophagus with celiac lymph node involvement between 2000 and 2007 were identified from a prospective database. Clinical and histopathological responses to chemotherapy were analyzed and follow-up comprised review of medical charts.
Twelve non-responding patients were not eligible for surgery. Twenty-six patients with partial responses or stable disease were operated on. The resectability rate was 96% (25/26) and tumor-free resection margins (R0) were achieved in 68% (17/25). The overall survival of patients with M1a disease was 16 months. Patients who received chemotherapy alone had a median survival of 10 months; patients who underwent additional surgery had a median survival of 26 months (log-rank P < 0.001).
The overall survival of patients with carcinoma of the distal esophagus and clinical celiac lymph node involvement is poor. Tumor-free resection margins (R0) in M1a patients with clinical response to chemotherapy are likely to be achieved and contributes to prolonged survival.
远端食管癌合并腹腔淋巴结转移（M1a）的患者预后较差，通常无法接受手术治疗。在本研究中，我们评估了对M1a期疾病患者采用化疗后手术的治疗策略。
从一个前瞻性数据库中识别出2000年至2007年间因远端食管癌合并腹腔淋巴结受累而接受化疗的38例患者。分析化疗的临床和组织病理学反应，并通过查阅病历进行随访。
12例无反应的患者不符合手术条件。26例部分缓解或病情稳定的患者接受了手术。切除率为96%（25/26），68%（17/25）的患者实现了无瘤切缘（R0）。M1a期疾病患者的总生存期为16个月。单纯接受化疗的患者中位生存期为10个月；接受额外手术的患者中位生存期为26个月（对数秩检验P<0.001）。
远端食管癌合并临床腹腔淋巴结受累患者的总生存期较差。对化疗有临床反应的M1a期患者可能实现无瘤切缘（R0），并有助于延长生存期。
