Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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, 10021, China.
Langenbecks Arch Surg. 2022 Nov;407(7):2673-2680. doi: 10.1007/s00423-022-02646-x. Epub 2022 Aug 25.
Adequate pulmonary function is important for patients undergoing surgical resection of esophageal cancer, especially those that received neoadjuvant therapy. However, it is unknown if pre-operative radiation affects pulmonary function differently compared to chemotherapy. The purpose of this study was to compare changes in pulmonary function between patients undergoing minimally invasive esophagectomy (MIE) who received neoadjuvant chemotherapy or chemoradiotherapy.
Between March 2017 and March 2018, esophageal cancer patients requiring neoadjuvant therapy were prospectively enrolled and randomly assigned to receive chemotherapy (CT) or chemoradiotherapy (CRT) before MIE. All patients received pulmonary function testing before and after the neoadjuvant therapy. Changes in pulmonary function, operative data, and pulmonary complications were compared between the 2 groups.
A total of 71 patients were randomized and underwent MIE after receiving CT (n = 34) or CRT (n = 37). Baseline clinical characteristics were comparable between the 2 groups. The CRT group experienced a greater decrease of forced expiratory volume at 1 s (FEV) (2.66 to 2.18 L, p = 0.023) and diffusion capacity of the lung for carbon monoxide divided by the mean alveolar volume (DLCO/Va) (17.3%, p < 0.001) than the CT group (FEV 2.53 to 2.41 L; DLCO/Va 4.8%). The incidence of pulmonary complications was higher in the CRT group (13.51 vs. 8.82%), but the difference was not significant (p = 0.532).
Preoperative CRT affects pulmonary function more than CT alone, but does not increase the risk of pulmonary complications in patients undergoing MIE.
对于接受食管癌手术切除的患者，尤其是接受新辅助治疗的患者，充足的肺功能很重要。然而，目前尚不清楚术前放疗与化疗相比是否会对肺功能产生不同的影响。本研究旨在比较接受新辅助化疗或放化疗的微创食管切除术（MIE）患者的肺功能变化。
2017 年 3 月至 2018 年 3 月，前瞻性纳入需要新辅助治疗的食管癌患者，并随机分为接受化疗（CT）或放化疗（CRT）后行 MIE。所有患者在新辅助治疗前后均接受肺功能检查。比较两组患者肺功能变化、手术数据和肺部并发症情况。
共 71 例患者随机分为 CT 组（n=34）和 CRT 组（n=37），分别接受 CT 或 CRT 后行 MIE。两组患者的基线临床特征相似。与 CT 组相比，CRT 组的用力呼气量（FEV）（2.66 降至 2.18 L，p=0.023）和一氧化碳弥散量/肺泡容积（DLCO/Va）（17.3%，p<0.001）下降更明显。CRT 组肺部并发症发生率更高（13.51%比 8.82%），但差异无统计学意义（p=0.532）。
术前 CRT 对肺功能的影响大于单独 CT，但不会增加行 MIE 患者肺部并发症的风险。
