术前放化疗结合微创手术治疗食管癌的临床与病理对照分析

目的评估术前同步放、化疗加微创手术治疗局部进展期食管癌的远、近期疗效及与病理的对应关系。方法将68例行微创食管Mckeown术式的局部进展期(Ⅱb~Ⅲa期)食管癌病例分为两组:观察组30例术前新辅助同步放、化疗再行手术治疗;对照组38例仅采用手术治疗。观察两组病例的围手术期一般指标与并发症、HE染色及免疫组化结果,并进行术后随访。结果观察组部分缓解率30%(9例),完全缓解率16.667%(5例),手术切除率100%。观察组围手术期一般指标及并发症等较对照组明显增多(P<0.05);观察组肿瘤复发转移率明显减低、无进展生存期延长(P<0.05)。观察组经过术前新辅助同步放、化疗治疗后,出现大片癌灶坏死消退,凋亡相关蛋白Casepase3与Casepase9表达水平明显较对照组高(P<0.05)。结论食管癌术前新辅助放、化疗可促进肿瘤降期,联合微创食管Mckeown手术疗效满意,并且有对应病理学改变,是一种临床值得推荐的治疗方案。

Clinical and pathological comparative analysis of preoperative radiotherapy and chemotherapy combined with minimally invasive surgery in the treatment of esophageal cancer

Purpose To evaluate the long-term and short-term efficacy of preoperative concurrent chemoradiotherapy plus minimally invasive surgery for locally advanced esophageal cancer and its relationship with pathology. Methods A retrospective study of 68 cases of locally advanced esophageal cancer (stage Ⅱb-Ⅲa) treated with minimally invasive Mckeown esophagectomy. They were divided into two groups. In the experimental group, 30 patients underwent neoadjuvant chemoradiotherapy followed by surgery. In the control group, 38 cases were just treated with operation. The outcome of follow-up included survival, HE section staining and immunohistochemistry results, recurrence and metastasis of tumors. Results In the experimental group, the partial remission rate was 30%(9 cases), the complete remission rate was 16.667%(5 cases), and the surgical resection rate was 100%. The general perioperative indexes and complications in the experimental group were significantly higher than those in the control group ( P <0.05). The recurrence and metastasis rate in the experimental group was lower than that in the control group ( P <0.05). The expression levels of apoptosis-related genes Casepase3 and Casepase9 in the observation group were significantly higher than those in the control group ( P <0.05). HE staining showed that after neoadjuvant chemoradiotherapy, large areas of cancer necrosis subsided. Conclusion Neoadjuvant chemoradiotherapy can decline the stage of tumor, combined esophagectomy is a safe and feasible treatment for locally advanced esophageal cancer. It has a good curative effect that is a recommended clinical treatment for locally advanced esophageal cancer.