内容紹介
The Efficacy of Definitive Chemoradiotherapy for Thoracic Esophageal Cancer on the Point of View Salvage Surgery
Summary
Introduction: Salvage surgery(S-surgery)was performed for residual or relapse tumor after definitive chemoradiotherapy(dCRT)for resectable esophageal cancer. When it becomes possible to perform surgery after dCRT for unresectable cases is called conversion surgery(C-surgery). Objective: To examine the outcomes of S-surgery and C-surgery after dCRT for thoracic esophageal cancer and clarify the significance as a multidisciplinary treatment. Material and methods: We reviewed 27 patients who underwent S-surgery for thoracic esophageal cancer in our hospital. 23 cases were residual tumor, 4 were relapse after complete response. Sixteen cases(59%)were C-surgery. Results: Five cases(19%)had non-radical resection. Two cases were postoperative hospital death(7%). Postoperative complications(Clavien-Dindo classification GradeⅡ and more)11 cases(41%). Four cases were anastomotic leakage, 4 cases vocal cord paralysis, etc. Pathological complete response cases 6 cases(22%). The recurrence cases were 7 except for 5 cases of non-radical resection. Three-year overall survival rate was 47%. Twelve cases(75%)in C-surgery could perform radical resection by down stage. Conclusions: The postoperative hospital mortality and complications can be considered as acceptable. dCRT is a powerful pre-operative treatment for such cases, and S-surgery plays an important role.
要旨
はじめに: 切除可能な病期に対する根治的化学放射線療法(dCRT)後の癌遺残や再発に対する手術をサルベージ手術(S手術)とし,切除不能であった局所進行胸部食道癌がdown stageし切除可能となった場合に行う手術をコンバージョン手術(C手術)とする。目的: 胸部食道癌に対するdCRT後のS手術とC手術のアウトカムを検討し,集学的治療としての意義を明らかにする。対象と方法: 当院で2012年4月～2016年12月までに胸部食道癌に対するdCRT後の根治目的の手術を施行した27例を対象とした。dCRT後の遺残23例,完全寛解後の再燃4例。うちC手術は16例(59%)であった。結果: 非根治切除は5例(19%)。術後在院死亡2例(7%)。術後合併症(Clavien-Dindo分類GradeⅡ以上)11例(41%)。縫合不全4例,声帯麻痺4例など。病理組織学的完全寛解症例6例(22%)。再発例は非根治切除の5例を除くと7例。3年全生存率47%。C手術のうち12例(75%)がdown stageにより根治切除を施行し得た。結論: S手術は,術後在院死亡や合併症を認めるが許容範囲内と考えられる。dCRT後の遺残・再発に対する唯一の根治治療であり,重要な役割を担う。
目次
Summary
Introduction: Salvage surgery(S-surgery)was performed for residual or relapse tumor after definitive chemoradiotherapy(dCRT)for resectable esophageal cancer. When it becomes possible to perform surgery after dCRT for unresectable cases is called conversion surgery(C-surgery). Objective: To examine the outcomes of S-surgery and C-surgery after dCRT for thoracic esophageal cancer and clarify the significance as a multidisciplinary treatment. Material and methods: We reviewed 27 patients who underwent S-surgery for thoracic esophageal cancer in our hospital. 23 cases were residual tumor, 4 were relapse after complete response. Sixteen cases(59%)were C-surgery. Results: Five cases(19%)had non-radical resection. Two cases were postoperative hospital death(7%). Postoperative complications(Clavien-Dindo classification GradeⅡ and more)11 cases(41%). Four cases were anastomotic leakage, 4 cases vocal cord paralysis, etc. Pathological complete response cases 6 cases(22%). The recurrence cases were 7 except for 5 cases of non-radical resection. Three-year overall survival rate was 47%. Twelve cases(75%)in C-surgery could perform radical resection by down stage. Conclusions: The postoperative hospital mortality and complications can be considered as acceptable. dCRT is a powerful pre-operative treatment for such cases, and S-surgery plays an important role.
要旨
はじめに: 切除可能な病期に対する根治的化学放射線療法(dCRT)後の癌遺残や再発に対する手術をサルベージ手術(S手術)とし,切除不能であった局所進行胸部食道癌がdown stageし切除可能となった場合に行う手術をコンバージョン手術(C手術)とする。目的: 胸部食道癌に対するdCRT後のS手術とC手術のアウトカムを検討し,集学的治療としての意義を明らかにする。対象と方法: 当院で2012年4月～2016年12月までに胸部食道癌に対するdCRT後の根治目的の手術を施行した27例を対象とした。dCRT後の遺残23例,完全寛解後の再燃4例。うちC手術は16例(59%)であった。結果: 非根治切除は5例(19%)。術後在院死亡2例(7%)。術後合併症(Clavien-Dindo分類GradeⅡ以上)11例(41%)。縫合不全4例,声帯麻痺4例など。病理組織学的完全寛解症例6例(22%)。再発例は非根治切除の5例を除くと7例。3年全生存率47%。C手術のうち12例(75%)がdown stageにより根治切除を施行し得た。結論: S手術は,術後在院死亡や合併症を認めるが許容範囲内と考えられる。dCRT後の遺残・再発に対する唯一の根治治療であり,重要な役割を担う。