Rocco G, Trastek V F, Deschamps C, Allen M S, Miller D L, Pairolero P C
Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 1998 Sep;66(3):894-6; discussion 897. doi: 10.1016/s0003-4975(98)00684-5.
This study examined the results of surgical treatment of leiomyosarcoma of the esophagus.
Between January 1920 and December 1996, 17 patients (9 men and 8 women) with leiomyosarcoma of the esophagus were treated surgically at the Mayo Clinic. Median age was 58 years and ranged from 26 to 76 years. Symptoms included dysphagia in 11 patients (64.7%) and odynophagia in 6 (35.3%). The tumor was located in the middle third of the esophagus in 10 patients (58.8%) and in the cervical esophagus in 7 (41.2%). Procedures performed included esophagogastrectomy in 9 patients (Ivor Lewis in 5, left thoracoabdominal in 3, and transhiatal in 1), enucleation in 3, transgastric excision in 1, and exploration without resection in 4.
The procedure was considered curative in 11 patients (64.7%). There was one operative death (mortality, 5.9%). Complications occurred in 3 patients (17.6%) and included anastomotic leak in 2 and bleeding requiring reoperation in 1. Growth pattern was infiltrating in 7, polypoid in 5, and intramural in 5. Histologically, the tumor was grade 1 in 6 patients, grade 2 in 2, grade 3 in 7, and grade 4 in 2. The tumor was postsurgically classified as stage I in 2 patients, stage IIA in 7, stage IIB in 1, stage IIIA in 5, stage IV in 1, and unknown in 1. Six patients (35.3%) received adjuvant treatment. Follow-up was complete in 16 patients (94.1%) and ranged from 1 to 182 months (median, 48 months). Five- and 10-year actuarial survivals were 47.0% and 31.0%, respectively. Seven patients (41.2%) are currently alive (median survival, 72 months); all underwent curative resection. Factors affecting survival included completeness of resection, growth pattern, postsurgical stage, tumor grade, and tumor location (p < 0.05).
We conclude that leiomyosarcoma of the esophagus is rare. Complete resection provides long-term survival.
本研究探讨了食管平滑肌肉瘤的外科治疗结果。
1920年1月至1996年12月期间，梅奥诊所对17例食管平滑肌肉瘤患者（9例男性，8例女性）进行了手术治疗。中位年龄为58岁，年龄范围在26至76岁之间。症状包括11例患者（64.7%）出现吞咽困难，6例（35.3%）出现吞咽痛。肿瘤位于食管中段的患者有10例（58.8%），位于颈段食管的患者有7例（41.2%）。所施行的手术包括9例食管胃切除术（5例采用艾弗·刘易斯术式，3例采用左胸腹联合切口术式，1例采用经裂孔术式），3例肿瘤摘除术，1例经胃切除术，4例仅行探查未进行切除。
11例患者（64.7%）的手术被认为是根治性的。有1例手术死亡（死亡率为5.9%）。3例患者（17.6%）出现并发症，包括2例吻合口漏和1例需要再次手术的出血。生长方式为浸润性的有7例，息肉样的有5例，壁内生长型的有5例。组织学上，6例患者的肿瘤为1级，2例为2级，7例为3级，2例为4级。术后肿瘤分期为Ⅰ期的患者有2例，ⅡA期的有7例，ⅡB期的有1例，ⅢA期的有5例，Ⅳ期的有1例，1例分期不明。6例患者（35.3%）接受了辅助治疗。16例患者（94.1%）获得了完整的随访，随访时间为1至182个月（中位时间为48个月）。5年和10年的精算生存率分别为47.0%和31.0%。7例患者（41.2%）目前仍存活（中位生存期为72个月）；所有患者均接受了根治性切除。影响生存的因素包括切除的完整性、生长方式、术后分期、肿瘤分级和肿瘤位置（P<0.05）。
我们得出结论，食管平滑肌肉瘤较为罕见。根治性切除可实现长期生存。
