术前放化疗加胸腹腔镜联合手术在局部中晚期食管癌中的应用体会

目的评估术前放化疗加胸腹腔镜联合手术治疗局部中晚期食管癌的可行性及近期疗效。方法2011年6月至2012年2月间浙江省台州医院共对11例局部中晚期（ⅡB-ⅢA期）食管癌患者予以术前放化疗加胸腹腔镜联合手术。术前化疗采取NP方案（长春瑞滨加顺铂）或TP方案（紫杉醇加顺铂）静脉注射；同期采用常规分割放疗，放疗剂量40Gy／20d。放化疗后4～6周施行胸腹腔镜联合经右胸、上腹、左颈三切口食管癌切除术。结果11例患者均完成预定同步放疗方案，期间9例出现不同程度的骨髓抑制。放化疗结束至手术的时间为（49．6±15．4）d。术中除1例患者（放化疗后75d手术）局部纤维化形成外，其余10例患者手术难度并未增加：与同期15例行单纯腔镜食管切除术的患者相比，手术时间明显缩短[（242．3±27．0）min比（280．5±27．2）min，P=0．002]，术中出血量明显减少[（168．2±95．6）ml比（244．5±84．8）ml，P=0．042]，淋巴结清扫数量相当[（19．5±5．8）枚／例比（20．5±7．1）枚／例，P=0．683]，但术后住院时间延长[（18．9±10．3）d比（12．5±4．6）d，P=-0．020]。术后病理示，4例瘤体明显缩小，7例达到病理完全缓解。术后并发症发生率36．4％（4／11），其中颈部吻合口瘘并肺部感染1例、颈部吻合口瘘并声嘶1例、肺部感染并胸腔积液2例。术后随访1～9个月，未见肿瘤复发。结论术前放化疗加胸腹腔镜联合手术治疗局部中晚期食管癌安全、可行．近期疗效确切。

Neoadjuvant chemoradiotherapy followed by combined thoracoscopic and laparoscopic esophagectomy in the treatment of locally advanced esophageal carcinoma

Objective To investigate the feasibility and efficacy of neoadjuvant chemoradiotherapy followed by combined thoracoscopic and laparoscopic esophagectomy （CTLE） in the treatment of advanced esophageal carcinoma. Methods From June 2011 to February 2012, 11 patients with locally advanced esophageal carcinoma underwent neoadjuvant chemoradiotherapy followed by CTLE （clinical stage ]1 B-mA）. NP （vinorelbine pin and cisplatin） or TP （programpaclitaxel-pin and cisplatin） were applied as preoperative chemotherapy. During the same period, conventional fractionated radiotherapy was used with the radiation dose of 40 Gy/20 F. At four to six weeks after CRT, 11 patients received three-incision CTLE. Results During chemoradiation, 9 patients developed bone marrow suppression. The interval between completion of chemoradiation and surgery was （49.6±15.4） d. Intraoperative findings revealed local fibrosis in one patient （75 days after chemoradiation） while operative difficulty was not increased in the remaining 10 patients. Compared to 15 patients who received surgery alone, operative time was shorter[ （242.3±27.0） min vs.（280.5±27.2） min, P=0.002] and intraoperative blood loss was less[ （168.2±95.6） ml vs. （244.5±84.8） ml, P=0.042], the number of removal lymph nodes was similar [ （19.5±5.8） vs. （20.5±7.1）, P=0.6831, postoperative hospital stay was prolonged [（18.9±10.3） d vs. （12.5±4.6） d, P=0.020]. The postoperative complication rate was 36.4% including cervical anastomotic leak with pulmonary infection （n=l）, cervical anastomotic fistula and hoarseness （n=1）, pulmonary infection with pleural effusion （n=2）. Follow up ranged from 1 to 9 months, and no recurrence was found. Conclusion The neoadjuvant ehemoradiotherapy followed by combined thoracoscopic and laparoscopic esophagectomy in the treatment of locally advanced esophageal carcinoma is safe, feasible, and the short-term outcomes are favorable.