Department of Surgery, Shinshu University School of Medicine, Japan.
Department of Surgery, Shinshu University School of Medicine, Japan.
Int J Surg. 2015 May;17:60-6. doi: 10.1016/j.ijsu.2015.02.022. Epub 2015 Mar 18.
The existence of other primary tumors during the treatment of esophageal cancer patients has been an important issue. Our aim is to investigate the prevalence and management of colorectal neoplasia (CRN) in surgically treated esophageal cancer patients.
Between 2002 and 2008, 93 patients with esophageal cancer were surgically treated. Seventy-three patients underwent subtotal esophagectomy and 20 underwent lower esophagectomy for esophageal cancer. Colonoscopy was available for detecting CRN before and after surgery.
Eighty-nine (95.7%) of the 93 patients were screened by colonoscopy preoperatively or within a year from the operation. Thirty-nine patients (43.8%) with CRN were synchronously identified: adenoma in 34 (38.2%) and adenocarcinoma in 5 patients (5.6%). Eleven adenomas with high grade-dysplasia and 8 adenomas with low grade-dysplasia were removed endoscopically. Three superficial adenocarcinomas were endoscopically removed before surgery, and 2 adenocarcinomas were surgically removed. Seventy-four patients (83.1%) were followed using colonoscopy, and 11 subsequent CRN, including 2 superficial adenocarcinomas, were endoscopically detected in 8 patients (10.8%). The size of esophageal cancer was larger in the patients with than without CRN (p = 0.036). The body mass index in esophageal cancer patients with CRN tended to be higher than in those without CRN (p = 0.065).
We noted that esophageal cancer is frequently associated with synchronous and/or metachronous colorectal cancer and adenomas. Colonoscopy is useful to detect and manage CRN before and after esophagectomy, although a few limitations exist.
在食管癌患者的治疗过程中存在其他原发性肿瘤一直是一个重要问题。我们的目的是研究接受手术治疗的食管癌患者中结直肠肿瘤（CRN）的患病率和治疗管理方法。
2002 年至 2008 年间，对 93 例食管癌患者进行了手术治疗。73 例患者接受了食管次全切除术，20 例患者接受了下段食管癌切除术。在手术前后，通过结肠镜检查来检测 CRN。
93 例患者中有 89 例（95.7%）通过术前或术后 1 年内的结肠镜检查进行了筛查。39 例（43.8%）患者同步发现 CRN：腺瘤 34 例（38.2%），腺癌 5 例（5.6%）。11 例高级别异型增生腺瘤和 8 例低级别异型增生腺瘤通过内镜切除。3 例早期腺癌通过内镜切除，2 例腺癌通过手术切除。74 例患者（83.1%）通过结肠镜检查进行随访，其中 8 例患者（10.8%）在 11 例患者中发现了 11 例后续 CRN，包括 2 例早期腺癌。伴有 CRN 的食管癌患者的食管癌肿瘤大小大于不伴有 CRN 的患者（p=0.036）。伴有 CRN 的食管癌患者的体重指数（BMI）也高于不伴有 CRN 的患者（p=0.065）。
我们发现食管癌常伴有同步和/或异时性结直肠癌和腺瘤。尽管存在一些局限性，但结肠镜检查对于在食管切除术前和术后发现和处理 CRN 非常有用。
