Kotaro Sugawara, Koichi Yagi, Takashi Fukuda, Shoh Yajima, Daiji Oka, Yoshiyuki Miwa, Shuichiro Oya, Asami Okamoto, Raito Asaoka, Yoshifumi Baba
{"title":"食道鳞状细胞癌患者行补救性食管切除术的生存结局:两个大容量研究中心的文献综述和结果","authors":"Kotaro Sugawara, Koichi Yagi, Takashi Fukuda, Shoh Yajima, Daiji Oka, Yoshiyuki Miwa, Shuichiro Oya, Asami Okamoto, Raito Asaoka, Yoshifumi Baba","doi":"10.1002/ags3.70028","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>This study aimed to investigate survival outcomes, the efficacy of lymph node (LN) dissection, and recurrence patterns in patients who underwent salvage surgery (SALV) for esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We retrospectively reviewed 69 patients with clinical stage I–IV thoracic ESCC who underwent SALV. Recurrence patterns and the distribution of LN metastases were analyzed according to the primary tumor location.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The 90-day mortality rate was 2.9%, and the 3-year overall survival (OS) rate of the 69 patients was 47.1%. OS curves were significantly stratified by the presence of abdominal LN metastases (<i>p</i> = 0.007). Among six patients whose clinically positive LNs were not dissected because their swelling disappeared after dCRT (cN+/CRT-cN0 cases), two (33.3%) developed locoregional recurrence. In contrast, among 25 patients whose clinically positive LNs were dissected regardless of CRT-cN status, the incidence of locoregional recurrence alone was 4.0%. Patients with lower thoracic (Lt) tumors had a higher incidence of distant metastases than those with middle (Mt) or upper thoracic (Ut) tumors (61.5% vs. 36.8%/33.3%). Mediastinal LN metastases were rare (7.7%) in Lt tumors, whereas LN metastases were widely distributed within the regional zones in Mt/Ut tumors. Patients with Lt tumors and pathological LN metastases had extremely poor OS (3-year OS: 0%).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Abdominal LN metastases had a negative impact on survival in ESCC patients who underwent SALV. Clinically positive LNs should be dissected, provided it is technically feasible. The tumor location might influence the distribution and prognostic impact of pathological LN metastases.</p>\n </section>\n </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 5","pages":"952-963"},"PeriodicalIF":3.3000,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70028","citationCount":"0","resultStr":"{\"title\":\"Survival Outcomes of Esophageal Squamous Cell Carcinoma Patients Who Underwent Salvage Esophagectomy: A Literature Review and Results From Two High-Volume Centers\",\"authors\":\"Kotaro Sugawara, Koichi Yagi, Takashi Fukuda, Shoh Yajima, Daiji Oka, Yoshiyuki Miwa, Shuichiro Oya, Asami Okamoto, Raito Asaoka, Yoshifumi Baba\",\"doi\":\"10.1002/ags3.70028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>This study aimed to investigate survival outcomes, the efficacy of lymph node (LN) dissection, and recurrence patterns in patients who underwent salvage surgery (SALV) for esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We retrospectively reviewed 69 patients with clinical stage I–IV thoracic ESCC who underwent SALV. Recurrence patterns and the distribution of LN metastases were analyzed according to the primary tumor location.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The 90-day mortality rate was 2.9%, and the 3-year overall survival (OS) rate of the 69 patients was 47.1%. OS curves were significantly stratified by the presence of abdominal LN metastases (<i>p</i> = 0.007). Among six patients whose clinically positive LNs were not dissected because their swelling disappeared after dCRT (cN+/CRT-cN0 cases), two (33.3%) developed locoregional recurrence. In contrast, among 25 patients whose clinically positive LNs were dissected regardless of CRT-cN status, the incidence of locoregional recurrence alone was 4.0%. Patients with lower thoracic (Lt) tumors had a higher incidence of distant metastases than those with middle (Mt) or upper thoracic (Ut) tumors (61.5% vs. 36.8%/33.3%). Mediastinal LN metastases were rare (7.7%) in Lt tumors, whereas LN metastases were widely distributed within the regional zones in Mt/Ut tumors. Patients with Lt tumors and pathological LN metastases had extremely poor OS (3-year OS: 0%).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Abdominal LN metastases had a negative impact on survival in ESCC patients who underwent SALV. Clinically positive LNs should be dissected, provided it is technically feasible. The tumor location might influence the distribution and prognostic impact of pathological LN metastases.</p>\\n </section>\\n </div>\",\"PeriodicalId\":8030,\"journal\":{\"name\":\"Annals of Gastroenterological Surgery\",\"volume\":\"9 5\",\"pages\":\"952-963\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-04-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70028\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Gastroenterological Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ags3.70028\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Gastroenterological Surgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ags3.70028","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:本研究旨在探讨食管癌(ESCC)患者在明确放化疗(dCRT)后接受挽救性手术(SALV)的生存结局、淋巴结(LN)清扫的疗效和复发模式。方法回顾性分析69例临床I-IV期ESCC行SALV手术的患者。根据原发肿瘤部位分析LN转移灶的复发模式及分布。结果69例患者90天死亡率为2.9%,3年总生存率为47.1%。OS曲线因腹部LN转移的存在而明显分层(p = 0.007)。在6例临床呈阳性的患者(cN+/CRT-cN0例)中,由于dCRT后肿胀消失而未切除的患者(cN+/CRT-cN0例),2例(33.3%)发生局部复发。相比之下,无论ct - cn状态如何,在25例临床阳性的患者中,仅局部复发的发生率为4.0%。下胸(Lt)肿瘤患者远端转移发生率高于中胸(Mt)或上胸(Ut)肿瘤患者(61.5% vs. 36.8%/33.3%)。Lt肿瘤中纵隔淋巴结转移罕见(7.7%),而Mt/Ut肿瘤中淋巴结转移广泛分布于区域内。Lt肿瘤和病理性LN转移患者的OS极差(3年OS: 0%)。结论腹腔淋巴结转移对接受SALV治疗的ESCC患者的生存有负面影响。如果技术可行,应解剖临床阳性的LNs。肿瘤的位置可能影响病理淋巴结转移的分布和预后。
Survival Outcomes of Esophageal Squamous Cell Carcinoma Patients Who Underwent Salvage Esophagectomy: A Literature Review and Results From Two High-Volume Centers
Background
This study aimed to investigate survival outcomes, the efficacy of lymph node (LN) dissection, and recurrence patterns in patients who underwent salvage surgery (SALV) for esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT).
Methods
We retrospectively reviewed 69 patients with clinical stage I–IV thoracic ESCC who underwent SALV. Recurrence patterns and the distribution of LN metastases were analyzed according to the primary tumor location.
Results
The 90-day mortality rate was 2.9%, and the 3-year overall survival (OS) rate of the 69 patients was 47.1%. OS curves were significantly stratified by the presence of abdominal LN metastases (p = 0.007). Among six patients whose clinically positive LNs were not dissected because their swelling disappeared after dCRT (cN+/CRT-cN0 cases), two (33.3%) developed locoregional recurrence. In contrast, among 25 patients whose clinically positive LNs were dissected regardless of CRT-cN status, the incidence of locoregional recurrence alone was 4.0%. Patients with lower thoracic (Lt) tumors had a higher incidence of distant metastases than those with middle (Mt) or upper thoracic (Ut) tumors (61.5% vs. 36.8%/33.3%). Mediastinal LN metastases were rare (7.7%) in Lt tumors, whereas LN metastases were widely distributed within the regional zones in Mt/Ut tumors. Patients with Lt tumors and pathological LN metastases had extremely poor OS (3-year OS: 0%).
Conclusions
Abdominal LN metastases had a negative impact on survival in ESCC patients who underwent SALV. Clinically positive LNs should be dissected, provided it is technically feasible. The tumor location might influence the distribution and prognostic impact of pathological LN metastases.