Roh Simon, Iannettoni Mark D, Keech John, Arshava Evgeny V, Swatek Anthony, Zimmerman Miriam B, Weigel Ronald J, Parekh Kalpaj R
Division of Interventional Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center.
Department of Cardiovasular Sciences, East Carolina University.
Korean J Thorac Cardiovasc Surg. 2019 Feb;52(1):1-8. doi: 10.5090/kjtcs.2019.52.1.1. Epub 2019 Feb 5.
Neoadjuvant chemoradiation therapy (nCRT) has become the standard of care for esophageal cancer patients prior to esophagectomy. However, the optimal timing for surgery after completion of nCRT remains unclear.
A retrospective review was performed of patients who underwent esophagectomy with cervical anastomosis for esophageal cancer at a single institution between January 2000 and June 2015. Patients were categorized into 3 cohorts: those who did not receive nCRT prior to esophagectomy (no nCRT), those who underwent esophagectomy within 35 days after nCRT (≤35d), and those who underwent esophagectomy more than 35 days after nCRT (>35d).
A total of 366 esophagectomies were performed during the study period, and 348 patients met the inclusion criteria. Anastomotic leaks occurred in 11.8% of all patients included in the study (41 of 348). Within each cohort, anastomotic leaks were detected in 14.7% of patients (17 of 116) in the no nCRT cohort, 7.3% (13 of 177) in the ≤35d cohort, and 20.0% (11 of 55) in the >35d cohort (p=0.020). Significant differences in the occurrence of anastomotic leaks were observed between the no nCRT and ≤35d cohorts (p=0.044), and between the ≤35d and >35d cohorts (p=0.007).
Esophagectomy with cervical anastomosis within 35 days of nCRT resulted in a lower percentage of anastomotic leaks.
新辅助放化疗（nCRT）已成为食管癌患者行食管切除术前的标准治疗方案。然而，nCRT完成后手术的最佳时机仍不明确。
对2000年1月至2015年6月期间在单一机构接受食管癌颈段吻合食管切除术的患者进行回顾性研究。患者分为3组：食管切除术前未接受nCRT的患者（无nCRT组）、nCRT后35天内接受食管切除术的患者（≤35天组）以及nCRT后35天以上接受食管切除术的患者（>35天组）。
研究期间共进行了366例食管切除术，348例患者符合纳入标准。纳入研究的所有患者中吻合口漏发生率为11.8%（348例中的41例）。在每个组中，无nCRT组患者吻合口漏检出率为14.7%（116例中的17例），≤35天组为7.3%（177例中的13例），>35天组为20.0%（55例中的11例）（p = 0.020）。无nCRT组与≤35天组之间（p = 0.044）以及≤35天组与>35天组之间（p = 0.007）吻合口漏发生率存在显著差异。
nCRT后35天内行颈段吻合食管切除术导致吻合口漏的比例较低。
