Cherveniakov A, Cherveniakov P
Emergency Medical Institute, N. I. Pirogov, Sofia, Bulgaria.
Eur J Cardiothorac Surg. 1993;7(11):601-4; discussion 605. doi: 10.1016/1010-7940(93)90247-9.
During the past 24 years we have treated 786 patients with esophageal and cardia carcinoma. En bloc resection of the tumor has been performed in only 461 (65.2%) of them and in 246 (34.7%) of the cases various palliative operations have been undertaken. Most of the patients were in stage II or III of the disease with squamous cell carcinoma in 80.5% and adenocarcinoma in 19.5% of them. The method of choice for the treatment of the patients with cardia and lower third of the esophagus carcinoma (n - 315) were blunt esophagectomy followed by colon (n - 256), stomach (n - 54) and/or jejunal (n - 9) substitution. The histology results confirmed the oncologic radical zone of resection of the esophagus from 8 cm above the tumor to 10-12 cm below in the stomach wall. This is the reason why substitution of the esophagus with stomach tube is very often impossible and the colon substitution remains the method of choice for such patients. The other important factor is radical resection of the tumor with the surrounding tissue, organs and lymph nodes involved (resection en bloc). The hospital mortality included 28 patients (7.3%) from the radically operated who also underwent esophageal substitution (n = 378). For these patients the 3-year survival rate is 51% (n - 191) and 5-year survival 46% (n - 172).
在过去24年里，我们共治疗了786例食管癌和贲门癌患者。其中仅461例（65.2%）进行了肿瘤整块切除，246例（34.7%）进行了各种姑息性手术。大多数患者处于疾病的II期或III期，其中80.5%为鳞状细胞癌，19.5%为腺癌。对于贲门癌和食管下段癌患者（n = 315），首选的治疗方法是钝性食管切除术，随后进行结肠（n = 256）、胃（n = 54）和/或空肠（n = 9）替代。组织学结果证实了食管肿瘤切除的肿瘤学根治范围为肿瘤上方8 cm至胃壁下方10 - 12 cm。这就是为什么用胃管替代食管往往是不可能的，而结肠替代仍然是这类患者的首选方法。另一个重要因素是肿瘤与周围组织、器官和受累淋巴结的根治性切除（整块切除）。医院死亡率包括28例（7.3%）接受根治性手术并同时进行食管替代的患者（n = 378）。这些患者的3年生存率为51%（n = 191），5年生存率为46%（n = 172）。
