Scarpa Marco, Noaro Giulia, Saadeh Luca, Cavallin Francesco, Cagol Matteo, Alfieri Rita, Plebani Mario, Castoro Carlo
Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Via Gattamelata 64 2, 35128, Padua, Italy,
World J Surg. 2015 Feb;39(2):424-32. doi: 10.1007/s00268-014-2835-1.
Esophagectomy is contraindicated in case of advanced cancer (i.e., carcinomatosis, distant metastasis, and invasion of other organs). In some cases, preoperative imaging may fail to identify advanced neoplasm and esophagectomy is inappropriately planned. The aim of the study was to identify preoperative biomarkers of occult advanced disease that force surgeons to abort the planned esophagectomy.
From 2008 to 2014, 244 consecutive patients were taken to the operative room to have esophagectomy for cancer in our department. All of them had blood test at admission and their preoperative biomarker data were retrieved. Their medical history was collected and the intraoperative findings and outcome were recorded. Non parametric tests, multiple regression analysis, and ROC curves analysis were performed.
In our study group, 14 (5.7 %) patients, scheduled for esophagectomy, were discovered to have occult advanced disease at laparotomy/laparoscopy or at thoracotomy. Six of them had peritoneal carcinomatosis, three had advanced tumor invading other organs, three had small liver metastasis, and two pleural carcinomatosis. In all these cases, esophagectomy was aborted and a feeding jejunostomy was placed. In patients with unresectable esophageal cancer, CA19.9 and CEA serum levels were significantly higher than patients who could have esophagectomy (p < 0.001 and p = 0.003, respectively). CA19.9 and CEA resulted to be accurate biomarkers of occult advanced disease (AUC = 85 %, p < 0.001 and AUC = 73 %, p = 0.002, respectively).
Preoperative CEA and CA19.9 serum levels should be taken in consideration when evaluating patients candidate to esophagectomy for esophageal cancer to prevent inappropriate laparotomy or thoracotomy. If any doubt arises minimally invasive exploration is warranted.
晚期癌症（即癌性腹膜炎、远处转移及侵犯其他器官）患者禁忌行食管切除术。在某些情况下，术前影像学检查可能无法识别晚期肿瘤，从而导致不恰当地计划进行食管切除术。本研究的目的是确定隐匿性晚期疾病的术前生物标志物，这些标志物会迫使外科医生放弃计划中的食管切除术。
2008年至2014年，我科连续244例患者因癌症接受食管切除术。所有患者入院时均进行了血液检查，并获取了他们术前的生物标志物数据。收集了他们的病史，并记录了术中发现及结果。进行了非参数检验、多元回归分析和ROC曲线分析。
在我们的研究组中，14例（5.7%）计划行食管切除术的患者在剖腹术/腹腔镜检查或开胸术时被发现患有隐匿性晚期疾病。其中6例有腹膜癌转移，3例有晚期肿瘤侵犯其他器官，3例有小的肝转移，2例有胸膜癌转移。在所有这些病例中，均放弃了食管切除术，并进行了空肠造口术以提供营养。在不可切除食管癌患者中，CA19.9和CEA血清水平显著高于可进行食管切除术的患者（分别为p < 0.001和p = 0.003）。CA19.9和CEA是隐匿性晚期疾病的准确生物标志物（AUC分别为85%，p < 0.001和73%，p = 0.002）。
在评估食管癌行食管切除术的患者时，应考虑术前CEA和CA19.9血清水平，以避免不恰当的剖腹术或开胸术。如果有任何疑问，有必要进行微创探查。
