Goel Ashish, Shah Swati H, Selvakumar Veda Padma Priya, Kahkasha S, Garg Shubha, Pahuja Anjali K, Dutta Kumardeep, Batra Ullas, Sharma S K, Doval D C, Kumar Kapil
Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, 110085 India.
Indian J Surg Oncol. 2015 Sep;6(3):207-12. doi: 10.1007/s13193-015-0402-3. Epub 2015 Apr 16.
Although preoperative chemoradiation has shown to improve surgical outcomes in both loco-regional control and long term survival; it has still not become the standard of care in many centers. There is reluctance in accepting preoperative chemoradiation primarily due to fear of increased perioperative morbidity/mortality or non-availability of infrastructure and expertise. We present a retrospective analysis of our results of radical esophagectomy after neoadjuvant chemoradiation. All patients who underwent Radical Esophagectomy from January 2009 to December 2013 by a single surgical team at our institute were included in the series (n = 118). Patients undergoing surgery after chemo-radiation (group A = 66) were compared with those under going upfront surgery (group B = 52) in terms of patient variables (age, sex, comorbidities, tumor location, staging, histology) and postoperative surgical outcomes and complications using Chi square test. Overall and disease free survival was analyzed using Kaplan Meir curve. There was no difference in duration of surgery, postoperative stay and overall morbidity and mortality in both groups. Although group A patients had more of advanced cases clinically, but histopathology showed complete pathological response (pCR) in nearly 40 % patients and negative nodes (pN0) in 62.5 % patients. OS and DFS showed a trend towards better survival with preoperative chemoradiation. We conclude that radical esophagectomy after preoperative chemoradiation is feasible and safe in developing countries. Moreover pathological complete response correlates well with improved survival. Randomized control trials may be required to further substantiate the results.
尽管术前放化疗已被证明可改善局部区域控制和长期生存方面的手术效果，但在许多中心它仍未成为标准治疗方法。主要由于担心围手术期发病率/死亡率增加或缺乏基础设施和专业知识，人们对接受术前放化疗存在抵触情绪。我们对新辅助放化疗后根治性食管切除术的结果进行了回顾性分析。本研究纳入了2009年1月至2013年12月在我院由单一手术团队进行根治性食管切除术的所有患者（n = 118）。采用卡方检验，比较了接受放化疗后手术的患者（A组 = 66）和直接进行手术的患者（B组 = 52）在患者变量（年龄、性别、合并症、肿瘤位置、分期、组织学）、术后手术结果及并发症方面的差异。使用Kaplan Meir曲线分析总生存期和无病生存期。两组在手术时间、术后住院时间、总体发病率和死亡率方面无差异。虽然A组患者临床上更多为晚期病例，但组织病理学显示近40%的患者有完全病理缓解（pCR），62.5%的患者淋巴结阴性（pN0）。术前放化疗的总生存期和无病生存期显示出更好的生存趋势。我们得出结论，在发展中国家，术前放化疗后进行根治性食管切除术是可行且安全的。此外，病理完全缓解与生存改善密切相关。可能需要进行随机对照试验以进一步证实这些结果。
