Salvage esophagectomy after definitive chemoradiotherapy: analysis of eighteen cases of a single operation group
10.3760/cma.j.issn.1001-4497.2018.02.003
- VernacularTitle:食管癌根治性放化疗后挽救性手术:单一手术组18例临床分析
- Author:
Xufeng GUO
1
;
Yifeng SUN
;
Yu YANG
;
Bo YE
;
Yang YANG
;
Xiaobin ZHANG
;
Rong HUA
;
Teng MAO
;
Zhigang LI
Author Information
1. 200030,上海交通大学食管疾病诊治中心 上海交通大学附属胸科医院胸外科
- Keywords:
Esophageal cancer;
Definitive chemoradiotherapy(dCRT);
Salvage resection
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2018;34(2):76-78
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the safety and efficacy of definitive chemoradiotherapy(dCRT) in esophageal cancer.Methods A retrospective analysis of 18 consecutive cases ofsalvage esophagectomy after dCRT by the single operation groupin department of Thoracic surgery,Shanghai chest hospital affiliated to Shanghai Jiaotong University from December 2014 to March 2017.Results 16 males and 2 females.There were 6 cases and 12 cases of recurrent and persistent tumor after dCRT respectively.All the patients were treated with McKeown operation stytle combing thoracic and abdominal lymph nodes dissection.Esophagus was replaced by stomach of 15 cases and colon of 3 cases respectively.Radical resection (R0) was performed in 12 cases,palliative resection (R2) in 6 cases.There were 4 cases of pathological complete response (pCR).The incidence of postoperative complications was 11 cases,including 6 cases of pulmonary infection,4 cases of anastomotic leak,2 cases of incision infection,one case of respiratory insufficiency,one case of recurrent laryngeal nerve paralysis,one case of chylothorax,one case of aortic bleeding caused by empyema.One patient died in perioperative period because of aortic bleeding due to empyema.The follow-up period was from 2 to 26 months,and the median follow-up time was 9 months.There were 13 patients survived and 5 patients died at the last follow-up date including one death in perioperative period,2 cases died of local-regional recurrence and metastasis respectively.Conclusion Salvage esophagectomy is a treatment option for the recurrent or persistent disease after dCRT,but the incidence of postoperative complications is high.Accurate clinical staging is especially important after dCRT and ycT4,ycN + patientsshould be avoided.R0 resection and recurrence after long disease free period are favorable prognostic factors.
