Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Thoracic Oncology, Henan Chest Hospital, Zhengzhou, China.
Dis Esophagus. 2021 Oct 11;34(10). doi: 10.1093/dote/doaa123.
Controversy still exists as to whether surgical treatment has any impact on the long-term survival of esophageal cancer (EC) patients with coronary artery disease treated with curative esophagectomy combined with off-pump coronary artery bypass grafting (OPCABG). Therefore, the aim of this study was to introduce and assess the effect of esophagectomy combined with OPCABG on both short- and long-term outcomes. From January 2010 to January 2015, 1428 EC or esophagogastric junction cancer patients underwent surgical treatment at Henan Chest Hospital, Zhengzhou, China. The clinical data of 25 patients who underwent EC resection through a left thoracotomy following OPCABG and the perioperative characteristics and follow-up results were analyzed. The majority of the patients were male, and the EC stage was predominantly cT2N0-1M0 II. The most common pathological types were squamous cell carcinoma. The EC surgeries consisted of 15 chest anastomosis procedures and 10 cervical anastomosis procedures with aortocoronary graft implantation (mean: 2.36 grafts per patient). The mean total operative time was 330.8 ± 83.5 minutes. The median intensive care unit and hospital lengths of stay were 1.72 and 21.16 days, respectively. Resection without macroscopic residual disease (R0) was achieved in all of the patients. The most frequent complications included pulmonary infections (24%), arrhythmias (24%), pleural effusion (12%), and esophageal anastomotic leakage (8%). There were no postoperative deaths or myocardial infarctions within 30 days after the surgery. The overall 1-, 3-, and 5-year survival rates were 88%, 40%, and 24%, respectively, with a median survival time of 43 months. In the short-term, radical resection of EC following OPCABG is a safe and feasible treatment with low postoperative mortality rates. In the long-term, simultaneous surgery is acceptable and is associated with favorable overall and disease-free survival.
对于行根治性切除术并同时接受不停跳冠状动脉旁路移植术（OPCABG）治疗的伴有冠状动脉疾病的食管癌（EC）患者，手术治疗对其长期生存的影响仍存在争议。因此，本研究旨在介绍并评估 EC 切除术联合 OPCABG 的短期和长期效果。2010 年 1 月至 2015 年 1 月，中国郑州河南胸科医院对 1428 例 EC 或食管胃交界癌患者进行了外科治疗。分析了 25 例行 OPCABG 后左开胸行 EC 切除术患者的临床资料、围手术期特点和随访结果。患者多数为男性，EC 分期以 cT2N0-1M0 II 期为主。最常见的病理类型为鳞状细胞癌。EC 手术包括 15 例胸内吻合术和 10 例颈吻合术，其中有主动脉-冠状动脉旁路移植术（平均每位患者 2.36 个移植物）。总手术时间的中位数为 330.8±83.5 分钟。中位重症监护病房和住院时间分别为 1.72 和 21.16 天。所有患者均达到无肉眼残留疾病（R0）的切除。最常见的并发症包括肺部感染（24%）、心律失常（24%）、胸腔积液（12%）和食管吻合口漏（8%）。术后 30 天内无死亡或心肌梗死发生。总 1、3、5 年生存率分别为 88%、40%和 24%，中位生存时间为 43 个月。在短期，EC 根治性切除术联合 OPCABG 是一种安全可行的治疗方法，术后死亡率较低。在长期，同期手术是可以接受的，并且具有良好的总生存和无病生存。
