Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital，Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Thoracic Surgery, Zhongshang Hospital, Fudan University, Shanghai; China.
Dis Esophagus. 2020 Aug 3;33(8). doi: 10.1093/dote/doz091.
Esophageal cancer has a high incidence among malignancies in China, but a comprehensive picture of the status of its surgical management in China has hitherto not been available. A nationwide database has recently been established to address this issue.
A National Database was setup through a network platform, and data was collected from 70 high-volume centers (>100 esophagectomies/per year) across China. Data was entered between January 2009 and December 2014, and was analyzed in June 2015 after a minimal follow-up of 6 months for all patients. 8181 patients with complete data who received surgery for primary esophageal cancer on the Database were included in the analysis.
In this series, there were 6052 males and 2129 females, with a mean age of 60.5 years (range: 22-90 years). The pathology in 95.5% of patients was squamous cell carcinoma. The pathological stage distribution was 1.2% in stage 0, 2.5% in Ia, 11.5% in Ib, 14.8% in IIa, 36.1% in IIb, 19.3% in IIIa, 8.3% in IIIb, 6.2% in IIIc. 1800 patients (22.0%) with locally advanced disease received preoperative neoadjuvant therapy and 3592 patients (43.9%) underwent postoperative adjuvant chemotherapy and/or radiotherapy. The esophagectomies were performed through left thoracotomy approach in 5870 cases (72.6%), through right chest approach in 2215 cases (27.4%) including right thoracotomy (21.3%) and VATS (6.1%). The 30-day postoperative mortality rate was 0.6% (43 patients), and the overall postoperative complication rate was 11.6% (951 patients). The 1-, 3-, and 5-year overall survival rates were 82.6%, 61.6%, and 52.9%, respectively.
This National Registry Database from high-volume centers provides a comprehensive picture of surgical management for esophageal cancer in China for the first time. Squamous cell carcinoma predominates, but there is heterogeneity with respect to the surgical approach and perioperative oncologic management. Overall, surgical mortality and morbidity rates are low, and good survival rates have been achieved due to improvement of surgical treatment technology in recent years.
食管癌是中国恶性肿瘤发病率较高的一种疾病，但中国食管癌外科治疗的整体情况尚不清楚。最近建立了一个全国性数据库来解决这个问题。
通过网络平台建立了一个全国数据库，从中国 70 个大容量中心（每年>100 例食管癌切除术）收集数据。数据于 2009 年 1 月至 2014 年 12 月录入，并在所有患者的随访时间至少为 6 个月后于 2015 年 6 月进行分析。在数据库中接受原发性食管癌手术的 8181 例完整数据患者纳入分析。
本系列中，男性 6052 例，女性 2129 例，平均年龄 60.5 岁（范围：22-90 岁）。95.5%的患者病理为鳞状细胞癌。病理分期分布为 0 期 1.2%，Ia 期 2.5%，Ib 期 11.5%，IIa 期 14.8%，IIb 期 36.1%，IIIa 期 19.3%，IIIb 期 8.3%，IIIc 期 6.2%。1800 例（22.0%）局部晚期疾病患者接受术前新辅助治疗，3592 例（43.9%）接受术后辅助化疗和/或放疗。5870 例（72.6%）采用左胸入路进行食管癌切除术，2215 例（27.4%）采用右胸入路，其中右开胸 21.3%，胸腔镜手术 6.1%。术后 30 天死亡率为 0.6%（43 例），总术后并发症发生率为 11.6%（951 例）。1、3、5 年总生存率分别为 82.6%、61.6%和 52.9%。
本研究首次从大容量中心提供了中国食管癌外科治疗的综合情况。鳞状细胞癌占主导地位，但在手术方法和围手术期肿瘤管理方面存在异质性。近年来，由于外科治疗技术的改进，手术死亡率和发病率较低，生存情况良好。
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