Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Thorac Surg. 2012 Dec;94(6):1862-8. doi: 10.1016/j.athoracsur.2012.07.042. Epub 2012 Sep 7.
Definitive chemoradiotherapy is associated with high local treatment failure rates, and surgical resection may be an appropriate salvage therapy. However, the efficacy and safety of salvage esophagectomy have not been elucidated fully. The clinical outcomes of salvage esophagectomy for locoregional failure after chemoradiotherapy were assessed.
Twelve patients who underwent salvage esophagectomy after chemoradiotherapy between January 2003 and November 2010 were included in this retrospective analysis. Baseline demographics and survivals of these patients were compared with 21 patients who did not receive salvage esophagectomy for locoregional failure only after chemoradiotherapy, identified from our own previous prospective trials.
The median age was 62.5 years (range 50 to 69) and all patients had squamous cell carcinoma. The median radiation dose was 54.0 Gy (range 41.4 to 66.0) and the median interval between completion of chemoradiation and surgery was 8.0 months (range 2.0 to 32.9). There were no in-hospital deaths. Pulmonary complication was the most common postoperative morbidity (42%), and anastomotic leakage occurred in 1 patient (8%). With a median follow-up period of 29.3 months (range 5.8 to 73.0), the overall 3-year survival rate was 58%. Patients with early pathologic stage disease (T1/2 and N0) showed significantly prolonged survival (p=0.03) compared with those with advanced pathologic stage (T3/T4 or N1). Patients with salvage esophagectomy had prolonged event-free survival and overall survival compared with those patients with locoregional failure who received primary chemotherapy or boost radiotherapy (p<0.001).
While salvage esophagectomy for locoregional failure after chemoradiotherapy should be employed with great caution, it appears to be a feasible and effective therapeutic option for highly selected patients, especially with early pathologic stage disease. Salvage esophagectomy can be recommended as the only current curative treatment option for patients with locoregional failure after chemoradiotherapy.
根治性放化疗后局部治疗失败率较高，手术切除可能是一种合适的挽救性治疗方法。然而，挽救性食管切除术的疗效和安全性尚未完全阐明。本研究评估了放化疗后局部区域复发行挽救性食管切除术的临床结果。
回顾性分析了 2003 年 1 月至 2010 年 11 月期间行挽救性食管切除术的 12 例放化疗后局部区域复发患者的临床资料。将这些患者的基线特征和生存情况与仅接受放化疗后局部区域复发而未行挽救性食管切除术的 21 例患者进行比较，后者的数据来源于本中心既往前瞻性研究。
中位年龄为 62.5 岁（50-69 岁），所有患者均为鳞状细胞癌。中位放疗剂量为 54.0 Gy（41.4-66.0 Gy），放化疗完成至手术的中位时间为 8.0 个月（2.0-32.9 个月）。无院内死亡病例。最常见的术后并发症为肺部并发症（42%），1 例患者（8%）发生吻合口漏。中位随访时间为 29.3 个月（5.8-73.0 个月），总 3 年生存率为 58%。病理分期较早（T1/2 和 N0）的患者生存时间明显长于病理分期较晚（T3/T4 或 N1）的患者（p=0.03）。与接受局部区域复发后单纯化疗或加量放疗的患者相比，行挽救性食管切除术的患者无病生存时间和总生存时间均延长（p<0.001）。
放化疗后局部区域复发行挽救性食管切除术应慎重选择，对于高度选择的患者，尤其是病理分期较早的患者，挽救性食管切除术似乎是一种可行且有效的治疗选择。对于放化疗后局部区域复发的患者，可推荐挽救性食管切除术作为唯一的根治性治疗方法。
