Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan.
Department of Palliative Medicine, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
Surg Endosc. 2018 Jan;32(1):391-399. doi: 10.1007/s00464-017-5688-5. Epub 2017 Jun 29.
Preoperative chemotherapy with cisplatin and 5-fluorouracil (CF) has become the standard treatment for resectable stage II/III thoracic esophageal carcinoma in Japan. Recently, preoperative triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) has been reported to be effective for locally advanced esophageal cancer. Thoracoscopic esophagectomy (TE) has been increasingly accepted worldwide for the treatment of esophageal cancer. We conducted a retrospective study to evaluate the safety and outcomes of TE after DCF therapy for patients with advanced esophageal cancer.
The medical records of 63 consecutive patients with esophageal squamous cell carcinoma who underwent thoracoscopic surgery after chemotherapy were reviewed. Thirty-four patients received neoadjuvant chemotherapy with CF, and 29 received DCF as first-line chemotherapy.
The clinical T stage was significantly higher in the DCF group than in the CF group (p < 0.0001), including 17 patients with T4. Lymph node metastasis was more frequent in the DCF group (p = 0.0005), and the clinical stage of the tumor was significantly higher in the DCF group than in the CF group (p = 0.0001). No significant difference existed between the two groups in operation time for the thoracic procedure (DCF 277.2 min vs. CF 302 min). Blood loss during the thoracic procedure was less in the DCF group than in the CF group (DCF 46.9 mL vs. CF 88.8 mL; p = 0.0056). No significant differences existed between the two groups in postoperative morbidity (DCF 34.5% vs. CF 47%) or mortality (DCF 0% vs. CF 2.9%) rates.
Our study suggests that TE after DCF therapy for advanced esophageal cancer is as safe as TE after CF therapy.
顺铂和 5-氟尿嘧啶（CF）的术前化疗已成为日本可切除 II/III 期胸段食管鳞癌的标准治疗方法。最近，多西紫杉醇、顺铂和 5-氟尿嘧啶（DCF）的术前三联化疗已被报道对局部晚期食管癌有效。胸腔镜食管切除术（TE）在世界范围内越来越多地被接受用于治疗食管癌。我们进行了一项回顾性研究，以评估 DCF 治疗后接受 TE 的晚期食管癌患者的安全性和结果。
回顾性分析了 63 例接受化疗后行胸腔镜手术的食管鳞癌患者的病历。34 例患者接受 CF 新辅助化疗，29 例患者接受 DCF 作为一线化疗。
DCF 组的临床 T 分期明显高于 CF 组（p<0.0001），包括 17 例 T4 期。DCF 组淋巴结转移更常见（p=0.0005），且肿瘤临床分期明显高于 CF 组（p=0.0001）。两组胸腔手术时间无显著差异（DCF 组 277.2 分钟 vs. CF 组 302 分钟）。DCF 组胸腔手术出血量少于 CF 组（DCF 组 46.9 毫升 vs. CF 组 88.8 毫升；p=0.0056）。两组术后发病率（DCF 组 34.5% vs. CF 组 47%）或死亡率（DCF 组 0% vs. CF 组 2.9%）无显著差异。
我们的研究表明，DCF 治疗晚期食管癌后行 TE 与 CF 治疗后行 TE 一样安全。
