RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH UPPER-THIRD ESOPHAGEAL CANCER
Kirkilevsky S.I., Krahmalyov P.S., Kondratsky Y.N., Frydel R.I., Zhukov Y.O.
Cancer of the upper esophagus (CUE) accounts for 10–15% of all esophageal cancers. Treatment results in patients with CUE are currently unsatisfactory. Basically, such patients receive definitive chemoradiation. Today there is no clear algorithm for surgical treatment. Aim: to improve the short-term and long-term results of treatment of patients with CUE by developing a method of optimal surgical intervention in the amount of one-time subtotal esophagectomy. Object and methods: The short-term and long-term results of combined treatment of 44 patients with CUE (core group) and 187 patients with middle lobe cancer of the intra-thoracic esophagus (CITE) (comparison group) were analyzed. Patients in both groups received neoadjuvant radiochemotherapy according to similar regimens. In the main group of 16 patients operated on the developed method (radical removal of the tumor with the imposition of transpleural mechanical esophageal-gastric anastomosis, nutritional microjejunostomy and drainage of the cervical space with left-sided cervicotomy), in others performed surgery by Lewis type (25) ot Toreck (3). In the comparison group, 92.4% of patients underwent surgery by Lewis type. Results: The short-term outcomes of treatment results of the treatment of patients in both groups were satisfactory, the complication rates were not significantly different. Performing subtotal esophagectomy after a course of preoperative radiochemotherapy allowed resection of the esophagus R0 with its intersection 2 cm above the upper edge of the tumor (instead of the traditional 4 cm). When evaluating long-term treatment results, it was found that disease-free survival of patients with CUE and CITE did not differ significantly. The totality of short-term and long-term results of subtotal esophagectomy in the context of the developed method of treatment of patients with CUE is justified and more appropriate than performing surgery on the Lewis type. Conclusion: application of the developed methodic of optimal surgical treatment of upper and middle esophageal cancer is justified and allows performing radical treatment to such patients. Also the results of treatment using the developed methodic are equal to results of radical treatment of patients with middle-third of the esophagus.
No comments » Add comment