分析外科治疗食管鳞癌的长期生存结果及影响因素。

回顾上海市胸科医院2012—2014年间外科治疗的所有食管鳞癌患者，选取其中经胸手术患者864例作为研究对象，分析患者的一般情况、手术方式、术后恢复及长期生存结果和影响因素。

864例患者中，男性占84.7%；cⅡ期和cⅢ期患者分别占44.9%%和30.4%。8.3%的患者采用新辅助治疗。右胸进路手术占88.7%，微创食管癌切除术(MIE)占23.6%。手术总体并发症发生率为41.8%；90 d病死率为3.1%；总体复发率为38.1%；1、3、5年总体生存率分别为85.5%、61.2%和49.3%。MIE患者的远期生存率为66.5%，高于开放手术的44.0%，差异有统计学意义(P<0.001)。与未行术后辅助治疗患者比较，术后辅助治疗在淋巴结阳性患者和阴性的T3N0患者中均显示可以改善总体生存率(33.3% vs 31.5%，P＝0.001；66.0% vs 49.5%，P＝0.004)。

外科手术联合术后辅助治疗可以获得比较满意的食管鳞癌远期生存效果，新辅助治疗的作用需进一步研究。

To analyze the long-term survival rates and influencing factors of surgical treatment of esophageal squamous cell carcinoma.

All patients with esophageal squamous cell carcinoma who underwent surgical treatment at Shanghai Chest Hospital from 2012 to 2014 were reviewed. 864 patients undergoing transthoracic surgery were selected as the study subjects. Their general conditions, surgical approaches, postoperative complications, and long-term survival outcomes were analyzed.

Of all the patients, 84.7% were men, and 44.9% and 30.4% were cII and cIII patients, respectively. Neoadjuvant therapy was used in 8.3% of patients. The right thoracic approach was used in 88.7% of patients. The proportion of minimally invasive surgery was 23.6%. The overall complication rate was 41.8%, and the 90-day mortality rate was 3.1%. The recurrence rate was 38.1%. The 1-year, 3-year, and 5-year overall survival rates were 85.5%, 61.2%, and 49.3%, respectively. Minimally invasive surgery improved long-term survival (MIE vs OPEN 66.5% vs 44.0%, P<0.001). Adjuvant therapy was shown to improve overall survival in both lymph node positive and negative T3N0 patients (33.3% vs 31.5%, P=0.001; 66.0% vs 49.5%, P=0.004).

Surgical resection combined with postoperative adjuvant therapy can achieve satisfactory long-term survival of esophageal squamous cell carcinoma. The role of neoadjuvant therapy requires further study.