Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France.
Department of Clinical Research & Investigation, Biostatistics & Methodology Unit, Paoli Calmettes Institute, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.
World J Surg Oncol. 2022 Mar 6;20(1):70. doi: 10.1186/s12957-022-02537-x.
To report the postoperative and oncological outcomes of transhiatal esophagectomy for locally advanced cancer of the gastroesophageal junction.
Medical records of 120 consecutive patients who underwent transhiatal esophagectomy for locally advanced cancer of the gastroesophageal junction with curative intent after neoadjuvant treatment between February 2006 and December 2018 at our center were reviewed.
All patients received either chemotherapy (46.7%) or chemoradiation (53.3%). The 90-day mortality and overall morbidity rates were 0.8% and 56.7%, respectively. Respiratory complications were the most common (30.8%). Anastomotic leakage occurred in 19 patients (15.8%), who were treated by local wound care (n = 13) or surgical drainage (n = 6). Recurrent laryngeal nerve injury occurred in 12 patients (9.9%). The median length of hospital stay was 15.5 days. The rate of R0 resection was 95.8%, and the median number of nodes removed was 17.5. Over a median follow-up of 77 months, the rate of recurrence was 40.8%, and the overall survival rates at 1, 3, and 5 years were 91%, 75%, and 65%, respectively. The median survival time was not reached. In multivariate analysis, disease stage was the only independent significant prognostic factor.
Transhiatal esophagectomy is a safe and effective procedure with good long-term oncological outcomes for locally advanced tumors after neo-adjuvant treatment. It can be recommended for all patients with cancer of the gastroesophageal junction, regardless of the Siewert classification, tumor stage, and comorbidities.
报告经新辅助治疗后行经食管裂孔根治性切除术治疗局部晚期胃食管交界部癌的术后和肿瘤学结果。
回顾性分析 2006 年 2 月至 2018 年 12 月期间，在我院接受经食管裂孔根治性切除术治疗局部晚期胃食管交界部癌的 120 例连续患者的病历资料，所有患者均接受新辅助治疗。
所有患者均接受化疗（46.7%）或放化疗（53.3%）。90 天死亡率和总发病率分别为 0.8%和 56.7%。最常见的是呼吸系统并发症（30.8%）。19 例（15.8%）患者发生吻合口漏，采用局部伤口护理（n=13）或手术引流（n=6）治疗。12 例（9.9%）患者发生喉返神经损伤。中位住院时间为 15.5 天。R0 切除率为 95.8%，中位切除淋巴结数为 17.5。中位随访 77 个月后，复发率为 40.8%，1、3、5 年总生存率分别为 91%、75%和 65%。中位生存时间未达到。多因素分析显示，疾病分期是唯一独立的预后因素。
经食管裂孔根治性切除术是一种安全有效的方法，对于新辅助治疗后局部晚期肿瘤具有良好的长期肿瘤学结果。可以推荐所有胃食管交界部癌患者使用，无论 Siewert 分类、肿瘤分期和合并症如何。
