全食管胃切除术加扩大淋巴结清扫术并横结肠间置术：一种治疗广泛性食管胃交界癌的方法。

Total esophagogastrectomy plus extended lymphadenectomy with transverse colon interposition: A treatment for extensive esophagogastric junction cancer.

作者信息

Ceroni Marco, Norero Enrique, Henríquez Juan Pablo, Viñuela Eduardo, Briceño Eduardo, Martínez Cristian, Aguayo Gloria, Araos Fernando, González Paulina, Díaz Alfonso, Caracci Mario

机构信息

Marco Ceroni, Enrique Norero, Juan Pablo Henríquez, Eduardo Viñuela, Eduardo Briceño, Cristian Martínez, Gloria Aguayo, Alfonso Díaz, Mario Caracci, Department of Digestive Surgery, Pontificia Universidad Católica de Chile School of Medicine, Hospital Sótero del Rio, Puente Alto, Santiago 8207257, Chile.

出版信息

World J Hepatol. 2015 Oct 8;7(22):2411-7. doi: 10.4254/wjh.v7.i22.2411.

DOI:10.4254/wjh.v7.i22.2411

PMID:26464757

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4598612/

Abstract

AIM

To review the post-operative morbidity and mortality of total esophagogastrectomy (TEG) with second barrier lymphadenectomy (D2) with interposition of a transverse colon and to determine the oncological outcomes of TEG D2 with interposition of a transverse colon.

METHODS

This study consisted of a retrospective review of patients with a cancer diagnosis who underwent TEG between 1997 and 2013. Demographic data, surgery protocols, complications according to Clavien-Dindo classifications, final pathological reports, oncological follow-ups and causes of death were recorded. We used the TNM 2010 and Japanese classifications for nodal dissection of gastric cancer. We used descriptive statistical analysis and Kaplan-Meier survival curves. A P-value of less than 0.05 was considered statistically significant.

RESULTS

The series consisted of 21 patients (80.9% men). The median age was 60 years. The 2 main surgical indications were extensive esophagogastric junction cancers (85.7%) and double cancers (14.2%). The mean total surgery time was 405 min (352-465 min). Interposition of a transverse colon through the posterior mediastinum was used for replacement in all cases. Splenectomy was required in 13 patients (61.9%), distal pancreatectomy was required in 2 patients (9.5%) and resection of the left adrenal gland was required in 1 patient (4.7%). No residual cancer surgery was achieved in 75.1% of patients. A total of 71.4% of patients had a postoperative complication. Respiratory complications were the most frequently observed complication. Postoperative mortality was 5.8%. Median follow-up was 13.4 mo. Surgery specific survival at 5 years of follow-up was 32.8%; for patients with curative surgery, it was 39.5% at 5 years.

CONCLUSION

TEG for cancer with interposition of a transverse colon is a very complex surgery, and it presents high post-operative morbidity and adequate oncological outcomes.

摘要

目的

回顾经横结肠间置行全食管胃切除术（TEG）并清扫第二站淋巴结（D2）的术后发病率和死亡率，并确定经横结肠间置的TEG D2的肿瘤学结局。

方法

本研究包括对1997年至2013年间接受TEG的癌症诊断患者进行回顾性分析。记录人口统计学数据、手术方案、根据Clavien-Dindo分类的并发症、最终病理报告、肿瘤学随访情况及死亡原因。我们采用2010年TNM分类和日本胃癌淋巴结清扫分类。我们使用描述性统计分析和Kaplan-Meier生存曲线。P值小于0.05被认为具有统计学意义。

结果

该系列包括21例患者（80.9%为男性）。中位年龄为60岁。2个主要手术指征为广泛的食管胃交界癌（85.7%）和双原发癌（14.2%）。平均总手术时间为405分钟（352 - 465分钟）。所有病例均采用经后纵隔横结肠间置进行替代。13例患者（61.9%）需要行脾切除术，2例患者（9.5%）需要行远端胰腺切除术，1例患者（4.7%）需要切除左肾上腺。75.1%的患者未实现残留癌手术切除。共有71.4%的患者出现术后并发症。呼吸并发症是最常见的并发症。术后死亡率为5.8%。中位随访时间为13.4个月。随访5年的手术特异性生存率为32.8%；对于接受根治性手术的患者，5年生存率为39.5%。