Otowa Y, Nakamura T, Takiguchi G, Yamamoto M, Kanaji S, Imanishi T, Oshikiri T, Suzuki S, Tanaka K, Kakeji Y
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
Eur J Surg Oncol. 2016 Mar;42(3):407-11. doi: 10.1016/j.ejso.2015.11.012. Epub 2015 Dec 10.
Enhancements in surgical techniques have led to improved outcomes for esophageal cancer. Recent findings have showed that esophageal cancer is frequently associated with multiple primary cancers, and surgical resection is usually complicated in such cases. The aim of this study was to clarify the clinical significance of surgery for patients with esophageal squamous cell cancer associated with multiple primary cancers.
The clinical outcomes of surgical resection for esophageal cancer were compared among 79 patients with antecedent and/or synchronous cancers (Multiple cancer group) and 194 patients without antecedent and/or synchronous cancers (Single cancer group).
The most common site of multiple primary cancers was the pharynx (36 patients; 29.7%), followed by the stomach (24 patients; 19.8%). The reconstruction method was more complicated in the Multiple cancer group as a result of the prolonged surgery time and increased blood loss. However, postoperative morbidity and overall survival (OS) did not differ between the two groups. After esophagectomy, metachronous cancers were observed in 26 patients, with 30 regions in total, and 93.1% were found to be curable. Sex was the only independent risk factors for developing metachronous cancer after esophagectomy.
The presence of antecedent and synchronous cancers complicates the surgical resection of esophageal cancer; however, no differences were found in the OS and postoperative morbidity between the two groups. Therefore, surgical intervention should be selected as a first-line treatment. Because second primary cancers are often observed in esophageal cancer, we recommend a close follow-up using esophagogastroduodenoscopy and contrast-enhanced computed tomography.
手术技术的进步使食管癌的治疗效果得到改善。最近的研究结果表明，食管癌常与多原发性癌相关，在这种情况下手术切除通常较为复杂。本研究的目的是阐明手术治疗食管鳞状细胞癌合并多原发性癌患者的临床意义。
比较了79例有既往和/或同期癌症患者（多癌组）和194例无既往和/或同期癌症患者（单癌组）食管癌手术切除的临床结果。
多原发性癌最常见的部位是咽部（36例；29.7%），其次是胃（24例；19.8%）。由于手术时间延长和失血增加，多癌组的重建方法更为复杂。然而，两组术后发病率和总生存率（OS）并无差异。食管切除术后，26例患者出现异时性癌，共30个部位，其中93.1%可治愈。性别是食管切除术后发生异时性癌的唯一独立危险因素。
既往和同期癌症的存在使食管癌的手术切除变得复杂；然而，两组的总生存率和术后发病率并无差异。因此，应选择手术干预作为一线治疗方法。由于食管癌患者常出现第二原发性癌，我们建议使用食管胃十二指肠镜和增强CT进行密切随访。
