Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Ann Thorac Surg. 2012 Jan;93(1):207-12; discussion 212-3. doi: 10.1016/j.athoracsur.2011.05.021. Epub 2011 Oct 1.
After neoadjuvant chemoradiation (CXRT) for esophageal cancer, surgery has traditionally been recommended to be performed within 8 weeks. However, surgery is often delayed for various reasons. Data from other cancers suggest that delaying surgery may increase the pathologic complete response rate. However, there are theoretical concerns that waiting longer after radiation may lead to a more difficult operation and more complications. The optimal timing of esophagectomy after CXRT is unknown.
From a prospective database, we analyzed 266 patients with resected esophageal cancer who were treated with neoadjuvant CXRT from 2002 to 2008. Salvage resections were excluded from this analysis. We compared patients who had surgery within 8 weeks of CXRT and those who had surgery after 8 weeks. We used multivariable analysis to determine whether increased interval between chemoradiation and surgery was independently associated with perioperative complication, pathologic response, or overall survival.
One hundred fifty patients were resected within 8 weeks and 116 were resected greater than 8 weeks after completing CXRT. Mean length of operation, intraoperative blood loss, anastomotic leak rate, and perioperative complication rate were similar for the two groups. Pathologic complete response rate and overall survival were also similar for the two groups (p=not significant). In multivariable analysis, timing of surgery was not an independent predictor of perioperative complication, pathologic complete response, or overall survival.
The timing of esophagectomy after neoadjuvant CXRT is not associated with perioperative complication, pathologic response, or overall survival. It may be reasonable to delay esophagectomy beyond 8 weeks for patients who have not yet recovered from chemoradiation.
在接受新辅助放化疗（CXRT）治疗食管癌后，传统上建议在 8 周内进行手术。然而，由于各种原因，手术往往会被推迟。来自其他癌症的数据表明，延迟手术可能会增加病理完全缓解率。然而，也存在理论上的担忧，即放疗后等待时间过长可能会导致手术难度增加和并发症增多。新辅助放化疗后行食管癌切除术的最佳时机尚不清楚。
我们从一个前瞻性数据库中分析了 2002 年至 2008 年间接受新辅助 CXRT 治疗的 266 例可切除食管癌患者的资料。这项分析排除了挽救性切除术患者。我们比较了在 CXRT 后 8 周内行手术的患者和在 8 周后行手术的患者。我们采用多变量分析来确定放化疗与手术之间的间隔时间增加是否与围手术期并发症、病理反应或总生存独立相关。
150 例患者在完成 CXRT 后 8 周内行手术，116 例患者在 8 周后行手术。两组的手术时间、术中出血量、吻合口漏发生率和围手术期并发症发生率相似。两组的病理完全缓解率和总生存率也相似（p 值均无显著意义）。多变量分析显示，手术时机不是围手术期并发症、病理完全缓解或总生存的独立预测因素。对于尚未从放化疗中恢复的患者，将食管癌切除术推迟至 8 周后可能是合理的。
新辅助 CXRT 后行食管癌切除术的时机与围手术期并发症、病理反应或总生存率无关。对于尚未从放化疗中恢复的患者，将食管癌切除术推迟至 8 周后可能是合理的。
