Effects of preoperative neoadjuvant chemotherapy on thoracoscopic and laparoscopic surgery and its impact on prognosis in patients with esophageal squamous cell carcinoma

doi:10.3877/cma.j.issn.2095-8773.2019.02.04

Abstract

Abstract:

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 .

Key words: Neoadjuvant chemotherapy, Esophageal carcinoma, Thoracoscopic and laparoscopic surgery

Xionghua Hua, Xiufeng Wei, Kefeng Shi, Yongkui Yu, Yin Li, Xiankai Chen, Qi Liu, Ge Qu, Haomiao Li, Rulin Qian. Effects of preoperative neoadjuvant chemotherapy on thoracoscopic and laparoscopic surgery and its impact on prognosis in patients with esophageal squamous cell carcinoma[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2019, 06(02): 91-96.

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URL: https://zhxbwkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8773.2019.02.04

https://zhxbwkdzzz.cma-cmc.com.cn/EN/Y2019/V06/I02/91

Figures/Tables 4

项目	联合治疗组（Ｎ＝80）	单纯手术组（Ｎ＝88）	χ²值	Ｐ值
性别[ｎ（％）]			0.262	＞0.05
男性	61（76.25）	64（72.73）
女性	19（23.75）	24（27.27）
年龄/（ $\overset{ˉ}{x}$ ±ｓ，岁）	73±5	71±4	0.744	＞0.05
部位[ｎ（％）]			4.731	＞0.05
胸上段	25（32.25）	22（25.00）
胸中段	36（45.00）	43（48.86）
胸下段	19（23.75）	23（26.14）
临床T分期[ｎ（％）]			0.257	＞0.05
T₂	9（11.25）	23（26.14）
T₃	63（78.75）	56（63.64）
T₄	8（10.0）	9（10.23）
临床N分期[ｎ（％）]			0.619	＞0.05
N₀	53（66.25）	57（64.77）
N₁	25（31.25）	27（30.68）
N₂	3（3.75）	4（4.55）

项目	联合治疗组（Ｎ＝80）	单纯手术组（Ｎ＝88）	χ²值	Ｐ值
性别[ｎ（％）]			0.262	＞0.05
男性	61（76.25）	64（72.73）
女性	19（23.75）	24（27.27）
年龄/（ $\overset{ˉ}{x}$ ±ｓ，岁）	73±5	71±4	0.744	＞0.05
部位[ｎ（％）]			4.731	＞0.05
胸上段	25（32.25）	22（25.00）
胸中段	36（45.00）	43（48.86）
胸下段	19（23.75）	23（26.14）
临床T分期[ｎ（％）]			0.257	＞0.05
T₂	9（11.25）	23（26.14）
T₃	63（78.75）	56（63.64）
T₄	8（10.0）	9（10.23）
临床N分期[ｎ（％）]			0.619	＞0.05
N₀	53（66.25）	57（64.77）
N₁	25（31.25）	27（30.68）
N₂	3（3.75）	4（4.55）

指标	联合治疗组（Ｎ＝80）	单纯手术组（Ｎ＝88）	Ｐ值
手术时间（min）	227.1±6.6	250.3±5.7	0.242
术中出血量（mL）	123.2±8.5	110.1±4.3	0.091
住院时间（d）	12.8±0.9	16.3±1.5	0.044
术后并发症[ｎ（％）]
吻合口瘘	2（2.50）	3（3.41）	0.528
肺部感染	7（8.75）	9（10.23）	0.297
心律失常	8（10.00）	9（10.23）	0.785
乳糜胸	1（1.25）	1（1.14）	0.776
胸腔感染	1（1.25）	2（2.3）	0.742
切口感染	1（1.25）	3（3.41）	0.601

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