新辅助同步放化疗联合食管癌腔镜三切口手术的临床疗效
Clinical effect of neoadjuvant chemo radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy
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摘要:
目的:探讨新辅助同步放化疗联合食管癌腔镜三切口手术的临床疗效及新辅助同步放化疗与手术的安全间隔时间。
方法:采用回顾性队列研究方法。收集2010年1月至2016年12月中国医学科学院北京协和医学院肿瘤医院收治的111例行新辅助同步放化疗联合食管癌腔镜三切口手术患者的临床病理资料。68例患者新辅助同步放化疗与食管癌胸腹腔镜联合三切口手术间隔时间<8周，设为<8周组；43例患者新辅助同步放化疗与食管癌胸腹腔镜联合三切口手术间隔时间≥8周，设为≥8周组。患者术前行放疗，同期采用TP方案行化疗。放化疗结束后择期行食管癌胸腹腔镜联合三切口手术。观察指标：(1)新辅助同步放化疗情况。(2)手术及术后情况。(3)随访情况。采用门诊和电话方式进行随访，了解患者术后生存和肿瘤复发、转移情况。随访时间截至2017年3月。正态分布的计量资料以
±s表示，组间比较采用 t检验；计数资料比较采用x2检验或Fisher确切概率法；等级资料比较采用非参数检验。
结果:(1)新辅助同步放化疗情况：<8周组和≥8周组患者均按疗程完成新辅助同步放化疗，无严重不良反应发生。 <8周组和≥8周组患者肿瘤病理学完全缓解例数分别为34例和15例，两组比较，差异无统计学意义(x2=2.441，P>0.05)。(2)手术及术后情况：<8周组和≥8周组患者均顺利完成手术，手术切缘均为阴性。 <8周组和≥8周组患者手术时间、术中出血量、淋巴结清扫数目、术后胸腔引流管拔除时间、术后颈部引流管拔除时间、声音嘶哑、上消化道出血、吻合口瘘、呼吸系统并发症、胸腔积液或积脓、心血管系统并发症、切口愈合不良、术后30 d内死亡、术后住院时间分别为(354±103)min和(343±92)min、(400±76)mL和(392±51)mL、(19±4)枚和(19±3)枚、(11±4)d和(12±6)d、(4.9±1.6)d和(4.5±1.0)d、5例和2例、1例和0、12例和7例、3例和5例、6例和3例、5例和4例、 8例和3例、0和2例、(19±17)d和(18±11)d，两组患者上述指标比较，差异均无统计学意义(t=1.080，0.569，0.326，1.223，1.286， x2=0.029，0.035，1.114，0.000，0.000，0.246，t=0.315，P>0.05)。(3)随访情况：111例患者中，90例获得术后随访，其中<8周组 55例，≥8周组35例。随访时间为3～82个月，中位随访时间为25个月。随访期间，<8周组患者中，9例死亡，11例肿瘤复发；≥8周组患者中，6例死亡，11例肿瘤复发。
结论:新辅助同步放化疗联合食管癌腔镜三切口手术安全有效，以8周左右为术前间隔时间，不增加围术期风险。Abstract:Objective:To explore the clinical effect of neoadjuvant chemoradiation combined with thoracoscopic and laparoscopic threeincision esophagectomy for esophageal cancer.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 111 esophageal cancer patients who underwent neoadjuvant chemoradiation combined with thoracoscopic and laparoscopic threeincision esophagectomy in the Cancer Hospital of Chinese Academy of Medical Sciences between January 2010 and December 2016 were collected. Among 111 patients, 68 with interval time between neoadjuvant chemoradiation and thoracoscopic and laparoscopic threeincision esophagectomy <-8 weeks were allocated into the <-8 weeks group and 43 with interval time between neoadjuvant chemoradiation and thoracoscopic and laparoscopic threeincision esophagectomy ≥8 weeks were allocated into the ≥8 weeks group. Patients underwent preoperative radiotherapy and chemotherapy with TP regimen, and then underwent selective thoracoscopic and laparoscopic threeincision esophagectomy. Observation indicators: (1) neoadjuvant chemoradiation situations; (2) surgical and postoperative situations; (3) followup. Followup using outpatient examination and telephone interview was performed to detect postoperative survival of patients and tumor recurrence or metastasis up to March 2017. Measurement data with normal distribution were represented as
±s and comparison between groups was analyzed using the t test. Count data were analyzed using the chisquare test or Fisher exact probability. Comparison of ranked data was done by the nonparametric test.
Results:(1) Neoadjuvant chemoradiation situations: all the patients underwent neoadjuvant chemoradiation, without severe adverse reaction. Number of patients with complete remission based on oncopathology were 34 in the <8 weeks group and 15 in the ≥8 weeks group, with no statistically significant difference between the 2 groups (x2=2.441, P>0.05). (2) Surgical and postoperative situations: all the patients underwent successful thoracoscopic and laparoscopic threeincision esophagectomy, with negative surgical margins. Operation time, volume of intraoperative blood loss, number of lymph node dissected, time of postoperative intrathoracic drainagetube removal, time of postoperative neck drainagetube removal, hoarseness, upper gastrointestinal hemorrhage, anastomotic fistula, respiratory complication, pleural effusion and empyema, cardiovascular complication, incision abnormal healing, death within postoperative 30 days and duration of hospital stay were (354±103)minutes, (400±76)mL, 19±4, (11±4)days, (4.9±1.6)days, 5, 1, 12, 3, 6, 5, 8, 0, (19±17) days in the <-8 weeks group and (343±92) minutes, (392±51)mL, 19±3, (12±6)days, (4.5±1.0)days, 2, 0, 7, 5, 3, 4, 3, 2, (18±11)days in the ≥8 weeks group, respectively, with no statistically significant difference between the 2 groups (t=1.080, 0. 569, 0.326, 1.223, 1.286, x2=0.029, 0.035, 1.114, 0.000, 0.000, 0.246, t=0.315, P>0.05). (3) Followup: 90 of 111 patients were followed up for 3-82 months, with a median time of 25 months, including 55 in the <8 weeks group and 35 in the ≥8 weeks group. During followup, death and tumor recurrence were detected in 9, 11 patients in the <8 weeks group and 6, 11 patients in the ≥8 weeks group, respectively.
Conclusion:Neoadjuvant chemoradiation combined with thoracoscopic and laparoscopic threeincision esophagectomy is safe and effective, and it doesn′t increase the perioperative risks based on preoperative 8week interval time. -
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