食管鳞癌混合分期患者 upfront 手术的结果：早期结果和长期生存。

Results of upfront surgery in a mixed stage population of patients with esophageal carcinoma: early outcome and long term survival.

机构信息

Department of Cardiothoracic Surgery, School of Medicine, Patras University Hospital, Patras, Greece.

出版信息

J BUON. 2021 Jul-Aug;26(4):1523-1530.

Abstract

PURPOSE

To evaluate early outcome and long term survival in a mixed stage population of patients undergoing upfront esophagectomy for esophageal cancer.

METHODS

Retrospective analysis of the data of 92 patients who underwent esophagectomy (thoracoabdominal: 76, Ivor-lewis: 16) between 1998 and 2017. Tumors were located in gastro-esophageal junction (52), lower third (31) and middle third (9) of the esophagus. Histology was: 73 adenocarcinomas and 19 squamous cell carcinomas. The stomach was used for reconstruction in 90 patients. A neck anastomosis was performed in 7 patients. End points of the study included: mortality, morbidity and long term survival. Kaplan-Meier and Cox regression analyses were used to identify prognostic factors for survival.

RESULTS

The mortality was 10.9% and 29 patients presented 49 complications. Anastomotic dehiscence occurred in 17.4% of the patients and represented the most common cause of death with mortality of 37.5%. Reoperation was necessary in 14 patients. Median survival reached 25 months with 3 and 5 year survival of 30.5% and 21% respectively. Early stage tumors, absence of nodal disease, well differentiated carcinomas and lymph node ratio ≤ 0.2 were associated with 5 year survival of 82.6%, 81.6%, 83.3% and 40.4% respectively. In multivariate analysis early stage disease (OR: 15.746, 95%CI: 4.332-58.579, p < 0.001) and lymph node ratio (OR: 1.700 95%CI: 1.051-2.752, p = 0.031) were statistically associated with long term survival.

CONCLUSIONS

Our results support the role of upfront surgery as the treatment of choice in early stage esophageal carcinomas without or with low nodal involvement.

摘要

目的

评估混合期食管癌患者行 upfront 食管切除术的早期结果和长期生存情况。

方法

回顾性分析 1998 年至 2017 年间行食管切除术（胸腹：76 例，Ivor-lewis：16 例）的 92 例患者的数据。肿瘤位于胃食管交界处（52 例）、下段（31 例）和中段（9 例）。组织学类型为：73 例腺癌和 19 例鳞癌。90 例患者使用胃重建，7 例患者行颈部吻合术。研究终点包括：死亡率、发病率和长期生存。采用 Kaplan-Meier 和 Cox 回归分析确定生存的预后因素。

结果

死亡率为 10.9%，有 29 例患者出现 49 种并发症。吻合口裂开发生率为 17.4%，是最常见的死亡原因，死亡率为 37.5%。14 例患者需要再次手术。中位生存时间达到 25 个月，3 年和 5 年生存率分别为 30.5%和 21%。早期肿瘤、无淋巴结疾病、高分化癌和淋巴结比率≤0.2 与 5 年生存率 82.6%、81.6%、83.3%和 40.4%相关。多因素分析显示早期疾病（OR：15.746，95%CI：4.332-58.579，p<0.001）和淋巴结比率（OR：1.700，95%CI：1.051-2.752，p=0.031）与长期生存相关。