Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ann Surg Oncol. 2011 Sep;18(9):2613-21. doi: 10.1245/s10434-011-1654-y. Epub 2011 Mar 16.
An esophagectomy followed by reconstruction for esophageal cancer is a highly aggressive operation. The purpose of this study was to justify a two-stage operation for high-risk patients with esophageal cancer.
The clinical results of 27 patients who underwent two-stage operation were compared with 118 patients who underwent a simultaneous resection and reconstruction (control subjects). The reasons for the selection of the two-stage operation were underlying general disease in 13 patients (liver dysfunction, n = 6; pulmonary disease, n = 3; poor performance status, n = 2; diabetes and renal failure, n = 1 each) and high-risk operation in 14 other patients (colon interposition, n = 7; salvage operation after definitive chemoradiotherapy, n = 4; and intraoperative events, n = 3). The patients initially underwent an esophagectomy and a cervical esophagostomy. Reconstruction was usually performed 2-3 weeks later.
The patients in the two-stage group were older than the control patients (mean 67.8 vs. 61.6 years old). The morbidity rate of the two-stage operation was 29.6%, which was not statistically different than control patients (32.2%). Postoperative complications in the two-stage operation were anastomotic leakage in 5 patients, and pneumonia and wound infection in 1 patient each. No patient experienced in-hospital death. The survival rates were not statistically different between the two groups.
A two-stage operation is a safe operation that prevents the occurrence of critical postoperative complications, and it thus may be considered an important treatment strategy for high-risk patients with esophageal cancer.
食管癌切除及重建术是一种极具侵袭性的手术。本研究旨在为高危食管癌患者的两阶段手术提供依据。
将 27 例接受两阶段手术的患者的临床结果与 118 例同期切除和重建（对照组）的患者进行比较。选择两阶段手术的原因是 13 例患者存在基础全身性疾病（肝功能障碍 6 例，肺部疾病 3 例，一般身体状况不佳 2 例，糖尿病和肾衰竭各 1 例）和 14 例其他高危手术患者（结肠间置术 7 例，根治性放化疗后挽救性手术 4 例，术中事件 3 例）。患者最初接受食管切除术和颈段食管造口术。重建通常在 2-3 周后进行。
两阶段组患者比对照组患者年龄更大（平均 67.8 岁 vs. 61.6 岁）。两阶段手术的发病率为 29.6%，与对照组患者（32.2%）无统计学差异。两阶段手术的术后并发症有 5 例吻合口漏，1 例肺炎和 1 例伤口感染。无患者院内死亡。两组患者的生存率无统计学差异。
两阶段手术是一种安全的手术，可以防止发生严重的术后并发症，因此可能是高危食管癌患者的一种重要治疗策略。
