Van Daele Elke, Scuderi Vincenzo, Pape Eva, Van de Putte Dirk, Varin Oswald, Van Nieuwenhove Yves, Ceelen Wim, Troisi Roberto, Pattyn Piet
a Department of Gastrointestinal and Hepatobilliairy Surgery , Ghent University Hospital, Ghent , Belgium.
Acta Chir Belg. 2018 Aug;118(4):227-232. doi: 10.1080/00015458.2017.1411557. Epub 2017 Dec 19.
Esophageal cancer (EC) remains an aggressive disease with a poor survival. Management of metastatic EC is limited to palliative chemotherapy (CT). Scientific contributions regarding the role of surgery are scarce and controversial. We analysed outcome of surgically treated metastatic EC patients.
We retrospectively identified surgically treated metastatic EC patients from our esophagectomy database. The aim of this study was to evaluate surgical complications, pathological response, oncological outcome and mean survival of these aggressively treated stage IV cancer patients.
Twelve stage IV patients with disease presentation limited to outfield lymph node (LN) and/or liver metastasis were treated with an aggressive multimodality treatment including surgery. Mean age was 58 years (75% male, 75% Adenocarcinomas). Median postoperative hospital stay was 15 d. Radiological anastomotic leakage occurred in one patient. In hospital, mortality was nil. Complete resection was achieved in all but one. Metastatic recurrence occurred in 64% of R0 resected patients. At date of censoring, after a median follow-up of 22 months, 50% of the surgical resected patients are still alive and 33% are free of disease recurrence. Kaplan-Meier curves show a possibility to long-term survival after aggressive multimodality therapy including surgery.
In selected metastatic EC patients, multimodality treatment including surgery has an acceptable surgical outcome with a potentially long-term survival.
食管癌（EC）仍然是一种侵袭性疾病，生存率较低。转移性EC的治疗仅限于姑息化疗（CT）。关于手术作用的科学贡献很少且存在争议。我们分析了手术治疗的转移性EC患者的预后。
我们从食管切除术数据库中回顾性地确定了接受手术治疗的转移性EC患者。本研究的目的是评估这些积极治疗的IV期癌症患者的手术并发症、病理反应、肿瘤学结局和平均生存期。
12例IV期患者，疾病表现局限于野外淋巴结（LN）和/或肝转移，接受了包括手术在内的积极多模式治疗。平均年龄为58岁（75%为男性，75%为腺癌）。术后中位住院时间为15天。1例患者出现放射性吻合口漏。住院期间无死亡病例。除1例患者外，所有患者均实现了完全切除。64%的R0切除患者发生转移性复发。在审查日期，中位随访22个月后，50%的手术切除患者仍然存活，33%的患者无疾病复发。Kaplan-Meier曲线显示，包括手术在内的积极多模式治疗后有可能实现长期生存。
在选定的转移性EC患者中，包括手术在内的多模式治疗具有可接受的手术结局，并且有可能实现长期生存。
