Kato H, Tachimori Y, Watanabe H, Yamaguchi H, Ishikawa T, Nakanishi Y, Ochiai A
Department of Surgery, National Cancer Center Hospital and Research Institute, Tokyo, Japan.
Eur J Surg. 1998 Oct;164(10):759-64. doi: 10.1080/110241598750005390.
To assess the incidence of anastomotic recurrence of oesophageal carcinoma and its relationship with proximal surgical margin invaded by tumour.
Retrospective study.
National Cancer Center, Tokyo.
463 patients with thoracic oesophageal squamous carcinoma who underwent transthoracic oesophagectomy with a minimal follow-up of three years.
Proximal surgical margin, anastomotic recurrence rate, prognosis.
Anastomotic recurrence developed in 12 of the 463 patients (3%), 10 of whom had histologically clear surgical margins. Sixteen patients had histologically invaded surgical margins, 13 of whom developed recurrent disease, 2 (13%) at the anastomosis. These 2 patients died of other diseases after treatment for their recurrent tumours. Two patients with anastomotic recurrence lived for over 5 years without signs of disease after excision of the recurrent tumour. Necropsy of 47 patients with recurrent tumors showed that only one (2%) was at the anastomosis.
Anastomotic recurrence was not inevitable and was rarely fatal in patients with invaded proximal surgical margins at transthoracic oesophagectomy. However, although infrequent, it did occur, even in patients with a cancer-free surgical margin. Resection may be indicated for patients with anastomotic recurrence and no other signs of metastases.
评估食管癌吻合口复发的发生率及其与肿瘤侵犯近端手术切缘的关系。
回顾性研究。
东京国立癌症中心。
463例胸段食管鳞状细胞癌患者，均接受了经胸段食管切除术，且至少随访3年。
近端手术切缘、吻合口复发率、预后。
463例患者中有12例（3%）发生吻合口复发，其中10例手术切缘组织学检查未见肿瘤残留。16例患者手术切缘组织学检查发现肿瘤侵犯，其中13例出现复发，2例（13%）为吻合口复发。这2例患者在复发病灶治疗后死于其他疾病。2例吻合口复发患者在切除复发病灶后存活超过5年，无疾病迹象。对47例复发肿瘤患者进行尸检发现，仅1例（2%）复发于吻合口。
在经胸段食管切除术近端手术切缘受侵犯的患者中，吻合口复发并非不可避免，且很少致命。然而，尽管发生率较低，但即使手术切缘无癌残留的患者也会发生。对于吻合口复发且无其他转移迹象的患者，可考虑行手术切除。
