新辅助化疗联合胸腹腔镜手术治疗食管癌  

Neoadjuvant chemotherapy followed by combined thoracoscopic and iaparoscopic esophagectomy in the treatment of esophagcal cancer

作　　者：冷长森 李印[1] 刘先本[1] 孙海波[1] 王总飞[1] 于永魁 李浩淼[1] 郑燕[1] 王伟[1] 崔莹莹[2] 

机构地区：[1]450008郑州大学附属肿瘤医院河南省肿瘤医院胸外科 [2]郑州大学第一附属医院

出　　处：《中华胸心血管外科杂志》2015年第9期519-522,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的对比食管癌患者行新辅助化疗联合胸、腹腔镜手术与单纯胸、腹腔镜手术的治疗效果。方法2011年1月至2013年12月治疗132例食管癌患者中62例（新辅助化疗组）先行2周期紫杉醇联合顺铂方案新辅助化疗，后行手术治疗；70例（单纯手术组）为同期直接行手术治疗者，手术方式均为胸、腹腔镜下食管癌根治术。结果新辅助化疗组均完成2个疗程的化疗；毒副反应中骨髓抑制3-4级占5％，消化道反应3—4级占7％，未出现严重的肝、肾功能损害；其中49例行手术治疗。术后并发症两组之间差异无统计学意义。新辅助化疗组中12例术后病理完全缓解，完全缓解率达19．4％。新辅助化疗组和单纯手术组的淋巴结转移率分别23％和51％（P=0．001）；淋巴结转移度分别为4．7％和7．6％（P〈0．001）；R0切除率分别为98％和87％（P=0．040）；中位生存期分别为32个月和28个月（P=0．041）。结论新辅助化疗联合胸、腹腔镜手术治疗食管癌疗效显著，能降低临床分期，提高手术根治性切除率，不增加手术并发症，可延长生存期。Objective Compare the treatment effects of chemotherapy followed by combined thoracoscopic and laparoseopic esophageetomy（CTLE） with CTLE alone in this patient population. Methods This study retrospectively analyzed 132 patients with esophageal cancer from January 2011 through December 2013. In these patients, 62 eases received neoadjuvant chemotherapy with paclitaxel and cisplatin for 2 cycles and followed by surgery（49 of them）. The other 70 cases were treated with surgery alone during the same period. Operation method of each group was CTLE. Results The toxic effects in the chemotherapy-surgery group were Grade 3 -4 bone marrow suppression（5% ） , Grade 3 -4 gastrointestinal reaction（7% ）. No serious liver and kidney function damage. Postoperative complications were similar in the two treatment groups. A pathological complete response was achieved in 12 patients（ 19.4% ） who underwent resection after chemotherapy. The metastatic lymph node ratio in chemotherapy-surgery group and the surgery group were 23% and 51% （ P =0. 001 ） , and the degree of lymphatic me- tastasis in the two groups were 4.7% and 7.6% （ P 〈 0. 001 ）. Complete resection with no tumor within 1 mm of the resection margins（ R0 ） was achieved in 98% of patients in the chemotherapy-surgery group versus 87% in the surgery group （ P = 0. 040）. Median overall survival was 32 months in the chemotherapy-surgery group versus 28 months in the surgery group. Overall survival was better in the chemotherapy-surgery group（ P = 0. 041 ）. Conclusion Paclitaxel combined with cisplatin in neoadjuvant chemotherapy for esophageal cancer can reduce the preoperative stage, enhance the radical resection rate, not increase the surgical complications , and improve survival.

关 键 词：食管肿瘤 胸腔镜 紫杉醇 顺铂 

分 类 号：R735.1[医药卫生—肿瘤]