Tanaka E, Okabe H, Tsunoda S, Obama K, Kan T, Kadokawa Y, Akagami M, Sakai Y
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Asian J Endosc Surg. 2012 Aug;5(3):111-7. doi: 10.1111/j.1758-5910.2012.00131.x. Epub 2012 Mar 5.
Minimally invasive esophagectomy has been increasingly accepted to treat esophageal cancer. In Japan, neoadjuvant chemotherapy followed by surgery has become the standard procedure for advanced esophageal cancer. A randomized control study has shown neoadjuvant chemotherapy's survival benefits, but it is unknown whether minimally invasive esophagectomy after chemotherapy is viable. This study investigated the feasibility of thoracoscopic esophagectomy after neoadjuvant chemotherapy.
From a database of patients with esophageal cancer, 105 patients who had undergone thoracoscopic esophagectomy with radical lymphadenectomy were analyzed retrospectively. Among them, 51 patients had received neoadjuvant chemotherapy with 5-fluorouracil and cisplatin (NAC group). Their operative outcomes, including operative duration, blood loss, the number of dissected lymph nodes, and postoperative morbidity and mortality, were compared with those of 54 patients who underwent surgery without neoadjuvant chemotherapy (control group). The efficacy of neoadjuvant chemotherapy was also assessed.
The operating time in the NAC group was significantly longer than in the control group (543 vs 472 min, P < 0.001), but the blood loss was less (323 vs 528 mL, P < 0.001). Recurrent laryngeal nerve palsy was the most frequently observed complication in both groups (27% vs 32%, P = 0.65). No significant differences were observed in the frequency of postoperative complications. There was no mortality in either group. In the NAC group, 43 patients (84.3%) underwent curative resection, and response of more than two-thirds of the pathological tumor was achieved in 11 patients (21.6%), including complete response in one patient (2.0%).
Thoracoscopic esophagectomy following neoadjuvant chemotherapy could be safely adopted for patients with advanced esophageal cancer.
微创食管切除术已越来越多地被用于治疗食管癌。在日本，新辅助化疗后再进行手术已成为晚期食管癌的标准治疗程序。一项随机对照研究显示了新辅助化疗对生存有益，但化疗后进行微创食管切除术是否可行尚不清楚。本研究调查了新辅助化疗后胸腔镜食管切除术的可行性。
从食管癌患者数据库中，回顾性分析105例行胸腔镜食管切除术并根治性淋巴结清扫术的患者。其中，51例患者接受了5-氟尿嘧啶和顺铂的新辅助化疗（NAC组）。将他们的手术结果，包括手术时间、失血量、清扫淋巴结数量以及术后发病率和死亡率，与54例未接受新辅助化疗而直接手术的患者（对照组）进行比较。同时评估新辅助化疗的疗效。
NAC组的手术时间明显长于对照组（543分钟对472分钟，P<0.001），但失血量较少（323毫升对528毫升，P<0.001）。双侧喉返神经麻痹是两组中最常见的并发症（27%对32%，P=0.65）。术后并发症发生率无显著差异。两组均无死亡病例。在NAC组中，43例患者（84.3%）接受了根治性切除，11例患者（21.6%）病理肿瘤反应超过三分之二，其中1例患者（2.0%）达到完全缓解。
新辅助化疗后胸腔镜食管切除术可安全地应用于晚期食管癌患者。
