Division of Gastrointestinal Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan.
World J Surg Oncol. 2022 May 23;20(1):163. doi: 10.1186/s12957-022-02637-8.
The esophagus has no serosa; therefore, esophageal cancer may quickly invade its adjacent organs. In recent years, reports of conversion surgery (CS) and salvage surgery (SS) have described resection of esophageal cancer previously considered unresectable, with the addition of intensive preoperative chemotherapy or chemoradiotherapy. Currently, there is no established method for determining whether tumor excision is possible. Additionally, differences in surgical approaches between facilities may influence outcome after resection. However, the option for resection is considered a significant factor in determining a patient's prognosis.
Patients who were diagnosed with advanced-stage (T3 or higher) squamous cell carcinoma of the esophagus and subsequently underwent resection with CS or SS were included in the study. Resection was performed through a small thoracotomy using a thoracoscope. Clinicopathologic factors, such as complete resection rate (R0) and prognosis, were investigated.
A total of 49 surgeries were conducted: 39 CS and 10 SS cases. The male-to-female ratio was 37:12. R0:R1:R2 equals 42:3:4, and the R0 resection rate was 85.7%. The 5-year survival rates for CS and SS cases were 69.2% and 32.1%, respectively. The 5-year survival rates for R0, R1, and R2 resections were 63.4%, 0.0%, and 25.0%, and those for R0 and R1 + 2 resections were 63.4% and 14.3%, respectively, indicating that the prognosis for R0 resection cases was significantly better (P = 0.001 and P = 0.001, respectively). Regarding chemotherapy for CS, 29 patients received 5-FU and cisplatin therapy, whereas 10 patients received 5-FU, cisplatin, and docetaxel (DCF) therapy. After 2015, the ratio of DCF was significantly high, and the R0 resection rate was 100% in patients who received DCF therapy.
In this study, a satisfactory R0 rate was achieved using the magnifying effect of the thoracoscope while ensuring safety during thoracotomy.
This was a single-center cohort study wherein clinical data were retrospectively registered. This study was approved by the Chiba Cancer Center review board (H29-262). All procedures adhered to the ethical standards of the responsible committee on human experimentation and the Helsinki Declaration of 1964 and its later amendments.
食管无浆膜层；因此，食管癌可能会迅速侵犯其邻近器官。近年来，有研究报告称，转换手术（CS）和挽救性手术（SS）可切除先前被认为不可切除的食管癌，同时进行强化术前化疗或放化疗。目前，尚无确定肿瘤能否切除的既定方法。此外，不同医疗机构的手术方法也可能影响切除后的结果。然而，能否进行切除被认为是决定患者预后的重要因素。
本研究纳入了经诊断患有晚期（T3 或更高）食管鳞状细胞癌且随后行 CS 或 SS 切除的患者。切除通过小开胸使用胸腔镜进行。研究调查了完整切除率（R0）和预后等临床病理因素。
共进行了 49 例手术：39 例 CS 和 10 例 SS。男女比例为 37:12。R0：R1：R2 分别为 42:3:4，R0 切除率为 85.7%。CS 和 SS 病例的 5 年生存率分别为 69.2%和 32.1%。R0、R1 和 R2 切除的 5 年生存率分别为 63.4%、0.0%和 25.0%，R0 和 R1+2 切除的 5 年生存率分别为 63.4%和 14.3%，表明 R0 切除病例的预后明显更好（P=0.001 和 P=0.001）。CS 中的化疗方面，29 例患者接受了 5-FU 和顺铂治疗，而 10 例患者接受了 5-FU、顺铂和多西他赛（DCF）治疗。2015 年后，DCF 的比例显著升高，接受 DCF 治疗的患者 R0 切除率达到 100%。
在本研究中，通过胸腔镜的放大效果，在确保开胸手术安全性的同时，获得了令人满意的 R0 率。
这是一项单中心队列研究，临床数据回顾性注册。本研究得到了千叶癌症中心审查委员会的批准（H29-262）。所有程序均符合负责人体实验委员会的伦理标准以及 1964 年赫尔辛基宣言及其后修正案。
