目的

探讨新辅助化疗对食管鳞癌患者胸腹腔镜手术及预后的影响。

方法

收集2012年1月—2013年12月收治的168 例食管鳞癌患者的资料，依据治疗方式分为新辅助化疗联合胸腹腔镜手术组（联合治疗组，n＝80）和单纯胸腹腔镜手术组（单纯手术组，n＝88）。联合治疗组术前给予多西紫杉醇联合顺铂方案的化疗（2 个周期）；单纯手术组为同期直接手术。手术方式均为胸腹腔镜食管癌根治术。比较两组术后并发症发生率、根治性切除率及淋巴结转移情况，采用Kaplan-Meier 方法进行生存分析。

结果

联合治疗组患者均完成2 个周期的化疗，完全缓解19 例（23 .8% ），部分缓解47 例（58 .8% ），客观有效率为82 .6% 。术后并发症两组间差异无统计学意义（P＞0 .05）；联合治疗组和单纯手术组的根治性切除率分别为93 .8% 和83 .0%，淋巴结转移率分别为23 .8% 和43 .3%，淋巴结转移度分别为6 .7% 和9 .3%，组间比较差异均有统计学意义（P＜0 .05）。第1、2、5年总生存率，联合治疗组分别为93 .3% 、72 .8% 和42 .7%，单纯手术组分别为90 .2% 、68 .9% 和36 .8%，两组间比较差异无统计学意义（P＞ 0 .05）；第1、2、5年无瘤生存率，联合治疗组为90 .2% 、62 .7% 和38 .8%，单纯手术组81 .1% 、54 .1% 和21 .6%，两组间比较差异有统计学意义（P＜0 .01）。

结论

食管鳞癌胸腹腔镜术前采用新辅助化疗可降低肿瘤临床分期，减少淋巴结转移风险，提高手术根治率，改善患者预后。

Objective

To explore the effects of preoperative neoadjuvant chemotherapy on thoracoscopic and laparoscopic surgery and the impact on prognosis in patients with esophageal squamous cell carcinoma .

Methods

This study retrospectively analyzed 168 patients with esophageal squamous cell carcinoma from January 2012 to December 2013 . In these patients , 80 cases received neoadjuvant chemotherapy with docetaxel and cisplatin for two treatment cycles and thoracoscopic and laparoscopic surgery (CTLS) afterwards . The other 88 cases were treated with CTLS alone . Postoperative complication rates ,radical resection rates , lymph-node metastasis and survival prognosis (by Kaplan-Meier Curve) were compared between the two groups .

Results

The patients with neoadjuvant chemotherapy can tolerate two-cycle chemotherapy . In the neoadjuvant chemotherapy group , the complete remission rate was 23 .8% ;the partial remission rate was 58 .8% ;therefore ,the total effective rate was 82 .6% . There was no significant difference in postoperative complications between the two groups( P＞0 .05) . The radical resection rate in the group of preoperative neoadjuvant chemotherapy followed by CTLS was 93 .8% ,which was higher than 89 .2% of CTLS alone . The difference between the two groups was statistically significant( P＜0 .05) . The metastatic lymph node ratio in the two groups were respectively 23 .8% and 43 .3% ( P＜0 .05) .The degree of lymphatic metastasis in the two groups were respectively6 .7% and 9 .3% ( P＜0 .05) . The overall 5-year survival rate for the patients with preoperative neoadjuvant chemotherapy followed by CTLS and the patients with CTLS alone was 42 .7% and 36 .8% respectively( P＞0 .05) .The 5-year tumor-free survival rate for the patients with preoperative neoadjuvant chemotherapy followed by CTLS and the patients with CTLS alone was 38 .8%and 21 .6% , respectively( P＜0 .01) .

Conclusions

Preoperative neoadjuvant chemotherapy for patients with esophageal squamous cell carcinoma can degrade the clinical stage of tumor , reduce the risk of lymph node metastasis ,improve radical resection rate and and improve the prognosis of patients .