Kofoed Steen Christian, Brandt Bodil, Brenø Jørn, Bardram Linda, Gustafsen Jens, Holm Jakob, Jendresen Marianne, Svendsen Lars Bo
Kirurgisk Afdeling C, Abdominalcenteret, Rigshospitalet, 2100 København Ø, Denmark.
Ugeskr Laeger. 2010 May 24;172(21):1597-602.
We present the long-term survival after curative resection for cancer at the gastro-oesophageal junction.
From 1992 through 2003, 147 patients with cancer at the gastro-oesophageal junction underwent curative resection. Preoperative evaluation included a computed tomography (CT) scan of the thorax and abdomen, gastroscopy, endoscopic ultrasonography and ultrasonography of the neck.
Explorative laparotomy was performed in 466 patients, and 147 underwent curative resection, while 319 had advanced disease. No patients received adjuvant chemo-radiotherapy. Adenocarcinoma was found in 93% of the patients and squamous cell carcinoma in 7%. Cardia resection was performed in 78%, while 22% underwent gastrectomy. R0 resection was performed in 95% of the operations. Anastomotic dehiscence was seen in 4%. The perioperative mortality after curative resection was 3% and the 180-day-mortality was 5%. The observed five-year survival rate after curative operation was 29% and the estimated five-year survival was 24%. The five-year survival rates according to tumour stage (T1-4) were 85%, 40%, 23% and 25%, respectively. After stratification according to lymph node metastases (-/+metastases) and age below/above 70 years, five-year survival rates were 41%/ 19% and 32%/17%, respectively. Cox regression analysis showed that no metastases (N0) and age below 70 years were independent predictors of survival.
The overall and stage-dependent survival after five years, perioperative mortality and complications are acceptable and comparative to those reported by foreign centres.
我们报告了胃食管交界部癌根治性切除术后的长期生存率。
1992年至2003年期间，147例胃食管交界部癌患者接受了根治性切除。术前评估包括胸部和腹部计算机断层扫描（CT）、胃镜检查、内镜超声检查以及颈部超声检查。
466例患者接受了剖腹探查术，其中147例接受了根治性切除，319例患有进展期疾病。没有患者接受辅助放化疗。93%的患者为腺癌，7%为鳞状细胞癌。78%的患者进行了贲门切除术，22%的患者进行了胃切除术。95%的手术实现了R0切除。吻合口裂开发生率为4%。根治性切除术后的围手术期死亡率为3%，180天死亡率为5%。根治性手术后观察到的五年生存率为29%，估计五年生存率为24%。根据肿瘤分期（T1 - 4）的五年生存率分别为85%、40%、23%和25%。根据有无淋巴结转移（- / +转移）以及年龄低于/高于70岁进行分层后，五年生存率分别为41% / 19%和32% / 17%。Cox回归分析表明，无转移（N0）和年龄低于70岁是生存的独立预测因素。
五年后的总体生存率和分期依赖性生存率、围手术期死亡率及并发症是可以接受的，与国外中心报告的情况相当。
