Department of Thoracic and Cardiovascular Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas 77030-4008, USA.
Ann Thorac Surg. 2012 Oct;94(4):1126-32; discussion 1132-3. doi: 10.1016/j.athoracsur.2012.05.106. Epub 2012 Aug 24.
Outcomes of salvage esophagectomy after definitive chemoradiation (CRT) for squamous cell carcinoma are well defined. Previous reports of salvage esophagectomy in patients with recurrent adenocarcinoma after definitive CRT are limited by small numbers and high morbidity and mortality rates.
We reviewed our experience of 65 patients with esophageal adenocarcinoma treated from 1997 to 2010 who underwent salvage esophagectomy after failed definitive CRT. We then compared this group to 65 matched patients of 521 total patients with esophageal adenocarcinoma who received preoperative CRT followed by planned esophagectomy. Propensity matching and multivariable analysis were performed.
Median time to surgery from completion of therapy for the salvage group was 216 days. Major postoperative events (major pulmonary event, conduit loss, leak, readmission to intensive care unit) occurred in 35% (23 of 65) of salvage patients and 31% (20 of 65) of the planned resection matched group. Anastomotic leak occurred in 18.5% (12 of 65) and 11.3 (59 of 521) of salvage and planned groups, respectively. Thirty-day mortality was 3.1% (2 of 65) after salvage resection and 4.6% (3 of 65) after planned resection. There was no difference in 3-year overall or median survival between the two groups of patients (32 months, 48% salvage, versus 40 months, 57% planned resection). Multivariable analysis did not identify salvage strategy or time from completion of therapy to resection as a predictor of major event or death.
Postoperative morbidity, mortality, and overall survival of patients after salvage esophagectomy are comparable to matched patients after planned resection. These results suggest that patients with esophageal adenocarcinoma who fail definitive CRT and recur locoregionally should be considered for salvage esophagectomy at experienced esophageal centers.
经过根治性放化疗（CRT）后，挽救性食管切除术治疗鳞状细胞癌的结果已经明确。先前关于根治性 CRT 后复发性腺癌患者接受挽救性食管切除术的报道数量有限，且发病率和死亡率较高。
我们回顾了 1997 年至 2010 年期间接受挽救性食管切除术的 65 例经根治性 CRT 治疗失败的食管腺癌患者的经验。然后，我们将该组与 521 例接受术前 CRT 后计划行食管切除术的食管腺癌患者中的 65 例匹配患者进行比较。进行了倾向匹配和多变量分析。
挽救组从完成治疗到手术的中位时间为 216 天。35%（23/65）的挽救组患者和 31%（20/65）的计划切除匹配组患者发生重大术后事件（重大肺部事件、导管丢失、漏液、再入住重症监护病房）。吻合口漏发生在挽救组和计划组中分别为 18.5%（12/65）和 11.3%（59/521）。挽救性切除术后 30 天死亡率为 3.1%（2/65），计划切除术后为 4.6%（3/65）。两组患者的 3 年总生存率和中位生存时间无差异（挽救组 32 个月，48%；计划切除组 40 个月，57%）。多变量分析未发现挽救策略或从完成治疗到切除的时间是重大事件或死亡的预测因素。
挽救性食管切除术后患者的术后发病率、死亡率和总生存率与计划切除术后的匹配患者相当。这些结果表明，在有经验的食管中心，经根治性 CRT 治疗失败且局部区域复发的食管腺癌患者应考虑接受挽救性食管切除术。
