Swisher Stephen G, Marks Jenifer, Rice David
Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
HealthOne Cardiothoracic Surgery Associates, The Medical Center of Aurora, Denver, Colorado, CO, USA.
Ann Cardiothorac Surg. 2017 Mar;6(2):144-151. doi: 10.21037/acs.2017.03.02.
Locoregionally advanced esophageal cancer is treated by some oncologists with definitive chemoradiation. The optimal strategy to treat persistent or recurrent disease after definitive chemoradiation is controversial. We reviewed the literature to determine current treatment options and optimal approaches. Salvage esophagectomy of relapsed or recurrent esophageal cancer has traditionally been associated with increased risk. Modern literature, however, suggests that in specialized high volume centers the risk of salvage esophagectomy when accompanied with various risk-reducing approaches (anastomosis in non-radiated esophagus, omental transposition, selective use of alternative conduits and two stage procedures) is similar to planned esophagectomy after neoadjuvant chemoradiation. Long-term survival rates following salvage esophagectomy are also achievable and similar to planned esophagectomy. Since there are no other potentially curable treatment options, we recommend that all physiologically fit patients with locoregionally persistent or recurrent esophageal cancer after definitive chemoradiation be referred to a specialized high volume esophageal center for salvage esophagectomy.
一些肿瘤学家采用确定性放化疗治疗局部晚期食管癌。确定性放化疗后治疗持续性或复发性疾病的最佳策略存在争议。我们回顾了文献以确定当前的治疗选择和最佳方法。传统上，复发性或转移性食管癌的挽救性食管切除术风险较高。然而，现代文献表明，在专业的高容量中心，采用各种降低风险的方法（在未受辐射的食管中进行吻合、网膜移位、选择性使用替代管道和两阶段手术）时，挽救性食管切除术的风险与新辅助放化疗后计划的食管切除术相似。挽救性食管切除术后的长期生存率也是可以实现的，并且与计划的食管切除术相似。由于没有其他潜在的可治愈性治疗选择，我们建议所有经确定性放化疗后局部持续性或复发性食管癌的身体状况适合的患者转诊至专业的高容量食管中心进行挽救性食管切除术。
