新辅助放化疗并全腔镜手术治疗局部晚期食管鳞癌的临床研究

目的评价新辅助放化疗并全腔镜手术治疗局部晚期食管鳞癌的疗效及安全性。方法选择局部晚期食管鳞癌患者70例,按抛硬币法随机分为新辅助放化疗并全腔镜手术(CRTS)研究组和单纯全腔镜手术(SA)对照组,每组35例。研究组采用多西他赛(60 mg/m2,D1)+顺铂(75 mg/m2,D1~D3),化疗2周期,同期行放疗,总剂量40 Gy,新辅助放化疗后3周行手术治疗。对照组行单纯手术治疗,两组手术均采用全腔镜食管癌根治术。比较两组患者的手术根治率、淋巴结转移率、术后并发症发生率、术后1、3年生存率的差异。结果研究组R0切除率为97.1%,对照组为82.9%;淋巴结转移率分别为31.4%和60.0%,两组比较差异均有统计学意义(P<0.05);两组术后并发症发生率分别为25.7%和22.9%,差异无统计学意义(P>0.05);研究组与对照组患者的1、3年总生存率分别为87.9%、71.9%和51.5%、37.5%;两组患者的3年生存率比较,差异有统计学意义(P<0.05)。结论新辅助放化疗并全腔镜手术治疗局部晚期食管鳞癌,较单纯手术能提高手术根治率,降低淋巴结转移率,改善3年生存率。

Clinical trial of neoadjuvant chemoradiotherapy plus minimally invasive esophagectomy for advanced esophageal squamous cell carcinoma

Objective To evaluate the curative effect of neoadjuvant chemoradiotherapy combined with minimally invasive esophagectomy （MIE） on advanced esophageal squamous cell carcinoma and its safety. Methods Seventy patients with advanced esophageal squamous ceil carcinoma were divided into CRTS （chemoradiotherapy followed by surgery） group and SA （surgery alone） group （ n = 35/group）. The ehemoradiotherapy （CRT） consisted of docetaxel 60 mg/m2 on day 1 and cisplatin 75 mg/m2 on day 1 -3 intravenously for 2 cycles, in combination with radiotherapy （40 Gy）. Surgery would be performed 3 weeks after chemoradiotherapy was completed. In SA group, the patients received surgery alone. Both the two groups underwent MIE via laparoscopy and thoracoscopy. Rates of complete resection, lymph node metastasis, postoperative complication and 1-and 3-year overall survivals were compared between the two groups. Results Rates of complete resection, lymph node metastasis, postoperative complication and 1- and 3-year overall survivals in CRTS group and in SA group were 97.1% vs. 82.9% （ P 〈 0.05 ） ,31.4% vs. 60.0% （ P 〈 0.05 ） ,25.7% vs. 22.9 % （ P 〉 0.05 ）, 87.9% vs. 51.5 % and 71.9% vs. 37.5 % （ P 〈 0.05 ）, respectively. Conclusion Neoadjuvant ehemoradiotherapy followed by MIE is more effective on advanced esophageal squamous cell carcinoma than surgery alone on the aspects of lowering lymph node metastasis and improving radical excision and 3- year survival rate.