Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Ann Thorac Surg. 2014 Jan;97(1):290-5. doi: 10.1016/j.athoracsur.2013.08.060. Epub 2013 Nov 5.
In T4 esophageal cancer with tracheobronchial invasion, an esophagorespiratory fistula (ERF) often occurs during or after chemoradiotherapy. We have performed esophageal bypass operations prior to definitive chemoradiotherapy for these patients to increase the chemoradiotherapy completion rate by minimizing the potential effect of an ERF. The aim of this study was to examine the clinical outcome of esophageal bypass surgery prior to chemoradiotherapy.
Between 1997 and 2010, 17 patients underwent esophageal bypass surgery followed by definitive chemoradiotherapy for esophageal cancer with tracheobronchial invasion (bypass group). Ten patients in the same circumstances were treated with chemoradiotherapy alone (control group). Overall survival, the clinical effect of chemoradiotherapy, the ERF incidence rate, and the safety of esophageal bypass surgery were assessed.
The overall response rate to chemoradiotherapy was 64.7% in the bypass group and 90.0% in the control group. Except for 2 patients with ERF at initial diagnosis, 4 (26.7%) of the 15 patients developed ERF in the bypass group, and 3 (30.0%) of the 10 patients developed ERF in the control group during or after chemoradiotherapy. The 2-year and 3-year overall survival rates were 17.6% and 17.6% in the bypass group and 20.0% and 0% in the control group, respectively (p = 0.924); long-term survival of more than 3 years was seen only in the bypass group.
Esophageal bypass surgery prior to definitive chemoradiotherapy could be performed safely, and this strategy contributed to long-term survival in the patients who achieved a good response to chemoradiotherapy but developed an ERF.
在 T4 期食管鳞癌合并气管支气管侵犯的患者中，在放化疗期间或之后经常会发生食管-呼吸道瘘（ERF）。我们对这些患者进行了食管旁路手术，以在进行确定性放化疗之前绕过食管，从而通过将 ERF 的潜在影响最小化来提高放化疗的完成率。本研究旨在探讨放化疗前进行食管旁路手术的临床效果。
1997 年至 2010 年间，17 例合并气管支气管侵犯的食管鳞癌患者接受了食管旁路手术联合确定性放化疗（旁路组）。同期，10 例患者单纯接受放化疗（对照组）。评估了两组患者的总生存率、放化疗的临床效果、ERF 发生率和食管旁路手术的安全性。
旁路组患者的总体缓解率为 64.7%，对照组为 90.0%。除了 2 例患者在初始诊断时即存在 ERF 外，旁路组有 4 例（26.7%）患者在放化疗期间或之后发生了 ERF，对照组有 3 例（30.0%）患者发生了 ERF。旁路组患者的 2 年和 3 年总生存率分别为 17.6%和 17.6%，对照组分别为 20.0%和 0%（p = 0.924）；只有旁路组有超过 3 年的长期生存。
在进行确定性放化疗之前进行食管旁路手术是安全的，对于那些对放化疗反应良好但发生 ERF 的患者，该策略有助于长期生存。
