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同步性食管癌和胃癌的同期切除

Simultaneous Resection of Synchronous Esophageal and Gastric Cancers.

作者信息

Park Byungjoon, Kim Hong Kwan, Choi Yong Soo, Kim Jhingook, Zo Jae Il, Shim Young Mog

机构信息

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.

出版信息

Thorac Cardiovasc Surg. 2016 Oct;64(7):611-618. doi: 10.1055/s-0036-1583166. Epub 2016 May 5.

Abstract

In patients with synchronous esophageal and gastric cancers, selecting an optimal conduit for esophageal reconstruction is a critical decision. The aim of this study was to evaluate the surgical outcomes after simultaneous resection of esophageal and gastric cancers according to the type of esophageal conduit used.  Clinicopathologic features and surgical outcomes were analyzed in 66 patients who underwent esophageal reconstruction with colon ( = 41, group C), jejunum ( = 11, group J), and stomach ( = 14, group S).  Gastric cancer was adenocarcinoma and esophageal cancer was squamous cell carcinoma in every case. Inhospital mortality rate was 4.6% ( = 3). The complication rates were 6.1% for graft failure and 9.1% for anastomotic leakage. During the follow-up period (mean, 44.0 ± 49.6 months), 5-year overall and disease-free survivals were 50.6 and 48.1%, respectively. Especially, patient with stage I cancer for both esophageal and gastric lesion showed excellent survival outcome with 5-year overall survival rate of 82.0%. There were no significant differences in early mortality, incidence of graft complications or overall survival between the groups. The independent predictors of overall survival were the highest tumor stage ( = 0.008) and age ( = 0.009).  Simultaneous resection of gastric and esophageal cancers can be performed with reasonable early and late outcomes. The type of esophageal conduit used was not a determinant factor for early and late outcomes.

摘要

对于同时患有食管癌和胃癌的患者,选择最佳的食管重建管道是一个关键决策。本研究的目的是根据所使用的食管管道类型评估同时切除食管癌和胃癌后的手术效果。分析了66例行食管重建术的患者的临床病理特征和手术效果,其中结肠重建41例(C组),空肠重建11例(J组),胃重建14例(S组)。所有病例中胃癌均为腺癌,食管癌均为鳞状细胞癌。住院死亡率为4.6%(3例)。移植失败的并发症发生率为6.1%,吻合口漏的发生率为9.1%。在随访期(平均44.0±49.6个月),5年总生存率和无病生存率分别为50.6%和48.1%。特别是,食管和胃病变均为I期癌症的患者生存结果良好,5年总生存率为82.0%。各组之间早期死亡率、移植并发症发生率或总生存率无显著差异。总生存的独立预测因素是最高肿瘤分期(P=0.008)和年龄(P=0.009)。同时切除胃癌和食管癌可以获得合理的早期和晚期效果。所使用的食管管道类型不是早期和晚期效果的决定因素。

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