Carlini S, Grauso F, Perri P, Pasquali Lasagni R, Piarulli L, Cavallari A, Bruno P, Benaglia A, Cerasoli V, Campioni N
Third Department of Surgery, Regina Elena Cancer Institute, Rome, Italy.
Hepatogastroenterology. 1997 Jan-Feb;44(13):187-91.
Neoplastic recurrence is the most common cause of death after surgery for esophageal cancer. The Authors review the therapeutic options evaluating in terms of palliation of dysphagia and complication and mortality rates. Prognostic factors and mechanisms determining the recurrence are also reviewed. A strategy for a rational approach in the management of recurrent esophageal cancer emerges from both the literature and their own experience. Notwithstanding the small life span of these patients, the treatment of esophageal obstruction is mandatory. The therapeutic options that be considered are: palliative resection, surgical bypass, laser therapy, intubation, radiotherapy. The site of obstruction, the presence of metastasis, the general status can lead to the optimal choice. In terms of palliation of dysphagia the surgical approach seems to obtain the best results, even if high complication and mortality rates have been reported. Bypass is the second surgical choice when applicable. The other non-surgical modalities have been administered in large series of patients with good results. Combination therapies can obtain better results.
肿瘤复发是食管癌手术后最常见的死亡原因。作者回顾了从吞咽困难缓解、并发症及死亡率方面评估的治疗选择。还回顾了决定复发的预后因素及机制。从文献及自身经验中得出了一种合理治疗复发性食管癌的策略。尽管这些患者生存期短，但治疗食管梗阻是必要的。可考虑的治疗选择有：姑息性切除、手术旁路、激光治疗、插管、放疗。梗阻部位、转移情况、一般状况可导向最佳选择。在缓解吞咽困难方面，手术方法似乎能取得最佳效果，即便已有报道称其并发症和死亡率高。适用时，旁路是第二种手术选择。其他非手术方式已应用于大量患者并取得良好效果。联合治疗可取得更好效果。
