Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812- 8582, Japan.
J Gastroenterol. 2011 Nov;46(11):1284-91. doi: 10.1007/s00535-011-0448-0. Epub 2011 Aug 5.
The purpose of this study was to clarify the effect of preoperative chemoradiotherapy (CRT) for esophageal cancer on the postoperative course, and to determine the clinical significance of salvage esophagectomy after definitive CRT.
Based on their preoperative treatment, 477 patients with esophageal cancer were classified into three groups: 253 patients who received surgery alone (Group I), 197 who received planned CRT (30-45 Gy, Group II), and 27 who received a salvage esophagectomy (radiation ≥60 Gy, Group III).
Postoperative complications developed in 25, 40, and 59% of the patients in Groups I, II, and III, respectively, with pulmonary complications developing in 10, 15, and 30%, and anastomotic leakage developing in 13, 23, and 37%, respectively. Mortality rates were 2.4, 2.0, and 7.4%, respectively. Multivariate analysis revealed preoperative therapy to be an independent factor associated with postoperative risks: the odds ratios (ORs) of Groups II and III compared to Group I were 1.8 and 4.0 for pulmonary complications, while they were 1.9 and 2.8, respectively, for anastomotic leakage. No critical complications developed in the 14 patients who received salvage surgery performed with strict surgical indications after 2005. The survival of Group III was not significantly different from that of Groups I and II. Most patients who received an R1/R2 resection after definitive CRT died within 2 years after salvage surgery.
Preoperative CRT is associated with postoperative complications especially in patients with R2 resection, while long-term survival can be achieved after R0 resections. Salvage surgery should be considered for carefully selected patients in whom R0 resection can be achieved.
本研究旨在阐明术前放化疗（CRT）对食管癌术后病程的影响，并确定根治性 CRT 后挽救性食管切除术的临床意义。
根据术前治疗情况，将 477 例食管癌患者分为三组：单纯手术 253 例（I 组）、计划 CRT（30-45 Gy）197 例（II 组）、挽救性食管切除术（放疗≥60 Gy）27 例（III 组）。
I、II、III 组患者术后并发症发生率分别为 25%、40%和 59%，肺部并发症发生率分别为 10%、15%和 30%，吻合口漏发生率分别为 13%、23%和 37%。死亡率分别为 2.4%、2.0%和 7.4%。多因素分析显示术前治疗是与术后风险相关的独立因素：与 I 组相比，II 组和 III 组肺部并发症的比值比（OR）分别为 1.8 和 4.0，吻合口漏的 OR 分别为 1.9 和 2.8。2005 年后，严格手术适应证行挽救性手术后的 14 例患者未发生严重并发症。III 组的生存与 I 组和 II 组无显著差异。大多数根治性 CRT 后行 R1/R2 切除术的患者在挽救性手术后 2 年内死亡。
术前 CRT 与术后并发症相关，尤其是在 R2 切除患者中，但 R0 切除后可获得长期生存。对于可实现 R0 切除的患者，应考虑进行挽救性手术。
