从临床研究探讨食管癌的最佳外科治疗策略

The best surgical treatment strategy for esophageal cancer based on clinical trials

  • 摘要: 根治性食管癌切除、彻底淋巴结清扫是减少食管癌术后复发转移、提高患者长期生存的关键。随着外科手术技术的提高,开放、腔镜、机器人等不同食管癌切除术均能安全开展。针对中下段食管鳞状细胞癌,外科手术需行包括上纵隔在内的彻底胸腹两野淋巴结清扫。然而,对于局部进展期食管癌,通常需要手术、放疗、化疗等多学科综合治疗。基于腺癌为主的临床研究,欧美学者认为新辅助放化疗较单独手术,能提高患者的生存率;而基于JCOG1109研究结果,日本学者认为在鳞癌患者中DCF方案(多西他赛、顺铂及5‑氟尿嘧啶)可作为新辅助化疗的标准治疗。在术后辅助治疗中,免疫治疗能改善新辅助放化疗后肿瘤残留患者的生存情况;免疫治疗在新辅助治疗中也逐渐显示出安全性和有效性。笔者通过手术入路选择、淋巴结清扫范围、多学科治疗等方面梳理分析食管癌外科治疗的临床研究,为食管癌的最佳外科治疗策略提供参考。

     

    Abstract: Curative esophagectomy and radical lymphadenectomy are the keys to reducing postoperative recurrence and metastasis, improving long‑term survival of patient. With the impro-vement of surgical techniques, open, minimally invasive and robotic esophagectomy could be performed safely. For middle and lower esophageal squamous cell carcinoma, radical thoracic-abdominal two-field lymphadenectomy in the upper mediastinum is needed. However, multidisciplinary treatment involving surgery, radiotherapy and chemotherapy is necessary for locally advanced esophageal cancer. Based on the clinical trials for esophageal adenocarcinoma, scholars from European and American believe that compared to surgery alone, neoadjuvant radiotherapy and chemotherapy can improve the survival of patients. According to the results of JCOG1109 research, scholars from Japan suggest that the DCF protocol (docetaxel, cisplatin and 5‑fluorouracil) could be the standard as neoadjuvant chemotherapy for esophageal squamous cell carcinoma. Regarding to postoperative adjuvant therapy, immunotherapy can improve survival for those with residual disease after neo-adjuvant chemoradiotherapy. For neoadjuvant therapy, the safety and efficacy of immunotherapy have also been proved. The authors review the clinical trials referring to surgical treatment including surgical approaches, extent of lymphadenectomy and multidisciplinary treatment, aiming to offer indications for the future best surgical treatment strategy for esophageal cancer.

     

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