颈段食管癌的外科治疗

目的总结外科治疗颈段食管癌的经验体会。方法综合分析1993年12月至2005年12月在河南省肿瘤医院胸外科和头颈外科接受外科治疗的82例颈段食管癌患者的临床资料。结果本组患者1997年以前以单纯手术治疗为主（27例）；1997年后，除5例早期癌患者外，50例常规采用半量放疗后再手术的综合治疗模式。非开胸食管切除73例．开胸食管切除9例；同期行单侧或双侧区域性颈淋巴结清扫14例；联合脏器切除12例。单纯手术组和综合治疗组保喉率分别为81．3％和95．8％，差异无统计学意义（P〉0．05）。无术中或术后大出血、气管和（或）支气管撕裂及围手术期死亡者；并发症发生率为19．5％；术后病理证实上切缘阳性5例，均为单纯手术组；淋巴结转移14例（17．1％）。全组5年总生存率43％：其中综合治疗组50．2％，高于单纯手术组的33．9％（Χ^2=7．17；P=0．007）；开胸食管切除者、同期行单侧或双侧区域性颈淋巴结清扫者和联合脏器切除者的5年生存率分别为36．5％、45．8％和33．3％。结论颈段食管癌患者半量放疗后再手术．可明显减少肿瘤上切缘阳性的发生率，提高保喉率和5年生存率。手术方式以非开胸游离食管为首选，联合脏器切除或双侧颈部淋巴结清扫应非常谨慎。

Experience of surgical treatment for cervical esophageal carcinoma

OBJECTIVE: To summarize the experience of surgical treatment for cervical esophageal carcinoma. METHODS: Clinical and follow-up data of 82 patients with cervical esophageal carcinoma undergone surgical treatment in Henan Provincial Cancer Hospital from Dec. 1993 to Dec. 2005 were analyzed retrospectively. The difference of the therapeutic regimen and 5-year survival rate of these patients were evaluated. RESULTS: Before 1997, patients mainly underwent surgical therapy solely (27 cases). After 1997, 50 cases received surgical therapy following neoadjuvant radiotherapy (multimodality group), except 5 early-stage cases received surgical therapy solely. Seventy-three patients underwent esophagectomy without thoracotomy, including 21 cases of invert-stripping of the esophagus, and 52 cases of blunt denudation of esophagus. Nine patients underwent transthoracic esophagectomy. Concurrent monolateral or bilateral cervical lymph node dissection accounted for 14 cases and combined organ resection 12 cases. No serious hemorrhage and tracheal or bronchial tearing occurred. No hospital death occurred. Postoperative complications were found in 14 patients, and the incidence of complication was 19.5%. In sole surgery group, upper incised margins of 5 patients were confirmed to be positive. The laryngeal function of 26 patients in sole surgery group was preserved, while 47 patients in multimodality group preserved. Lymph node metastasis occurred in 14 cases, including 13 cases cervical lymph node metastasis (monolateral 9, bilateral 4) and 1 case of upper mediastinal lymph node metastasis. During follow-up, 3 patients were lost. The total 5-year survival rate was 43%. The patients in multimodality group had higher 5-year survival rate as compared to those in sole surgery group. (50.2% vs 33.9%,chi(2 )=7.17,P=0.007). The 5-year survival rates of patients with transthoracic esophagectomy, esophagectomy plus concurrent monolateral or bilateral cervical lymph nodes dissection or combined organ resection were 36.5%, 45.8% and 33.3% respectively. All the 5-year survival rates of these subgroups were lower as compared to multimodality group. CONCLUSIONS: For patients with early stage cervical esophageal carcinoma and with proximal end of residual normal esophagus longer than 2 cm, the optimal therapy should be surgery. For most of the patients, surgery combined with neoadjuvant radiotherapy is the ideal therapeutic strategy, which can lower the risk of positive recised margin, improve the possibility of preserving the laryngeal function and result in the improvement of 5-year survival rate. Esophagectomy without thoracotomy should be preferred. Combined organ resection or bilateral lymph node dissection should be chosen carefully because these operating procedures may lead to severe injury and function lose.