Neoadjuvant chemoradiotherapy combined with mini-invasive esophagectomy in advanced esophageal cancer: A case report
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摘要: 局部晚期食管癌不可切除率及根治术后复发率较高。新辅助放化疗联合手术切除是最常见的食管癌多学科综合治疗方法之一，具有以下优点：减少肿瘤负荷，降低肿瘤分期，提高R0切除率；控制微转移，提高肿瘤局部控制率，改善预后。传统开胸手术通常伴随较高的并发症发生率和死亡率，影响术后生活质量；而胸腔镜辅助微创手术可有效减少手术创伤，加快术后恢复，且具有与开胸手术相似的远期疗效。现介绍1例经天津医科大学肿瘤医院食管肿瘤科治疗的进展期食管癌新辅助放化疗结合胸腔镜微创手术治疗的病例，该患者经多学科协作诊疗后效果较好。通过报道该病例诊治以促进食管癌新辅助治疗及微创外科经验交流，推动多学科间的合作。Abstract: Advanced esophageal cancer without distant metastasis remains a potentially curable disease, but the prognosis is poorer in this condition than in the early stage because of a high unresectability rate at presentation and a much higher recurrence rate after radical surgery. The administration of neoadjuvant chemoradiotherapy has several potential benefits for advanced esophageal cancer. This treatment can reduce tumor volume, decrease tumor stage, and improve R0 resection rate; can act on micrometastases, improve local control rate, and improve prognosis; and can evaluate tumor sensitivity to cytotoxic medications. Compared with the increased morbidity and mortality by traditional open procedure, mini-invasive esophagectomy has been associated with less blood loss, reduced postoperative pain, decreased time in the intensive care unit, and shortened length of hospital stay, but with similar long-term prognosis. The current study presents an advanced esophageal cancer patient who underwent neoadjuvant chemoradiotherapy combined with mini-invasive esophagectomy in our hospital. The multimodal treatment achieved a favorable curative effect for the patient. The report aims to promote comprehensive integration of esophageal cancer neoadjuvant therapy and mini-invasive procedure. This study can also enhance interdisciplinary communication and cooperation among medical colleagues in the same fields.
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图 1 新辅助治疗前后CT表现
Figure 1. CT presentation before (left) and after (right) neoadjuvant chemoradiotherapy
A：Esophageal stenosis，wall thickening，disappearance of the fat triangle；B：Esophageal wall thinning，part recovery of the fat triangle；C：Meniscus trace of inferior pulmonary vein by tumor impression；D：Tending to normal trace of inferior pulmonary vein
图 2 新辅助治疗前后上消化道造影表现
Figure 2. Upper gastrointestinal radiography presentation before (left) and after (right) neoadjuvant chemoradiotherapy
A：Esophageal stenosis，esophagectasis and fluid level，mucosal disorders；B：Smooth mucosal without obvious sigh of tumor；C：Huge filling-defect；D： Smooth mucosal without obvious sigh of tumor
表 1 治疗方案
Table 1. Treatment regimens
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