17 января 2002 00:00 |
Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy
Objectives: Some patients and oncologists choose to treat localized esophageal cancer with definitive chemotherapy and radiation therapy rather than surgery. A subset of these patients have local relapse without distant metastases and therefore have no other curative intent treatment option but salvage esophagectomy.
Methods: We reviewed our experience with salvage esophagectomy from 1987 to 2000 at M.D. Anderson Cancer Center (n = 13, salvage after chemotherapy and radiotherapy group) and compared the data with those of patients receiving esophagectomy in a planned fashion 4 to 6 weeks after preoperative chemotherapy and radiation therapy (n = 99, preoperative chemotherapy and radiotherapy group).
Results: Increases in morbidity were seen after resection in the salvage after chemotherapy and radiotherapy group relative to the preoperative chemotherapy and radiotherapy group: mechanical ventilation (9.0 days vs 3.3 days, P = .08), intensive care unit stay (11.2 days vs 5.1 days, P = .07), hospital stay (29.4 days vs 18.4 days, P = .03), and anastomotic leak rates (5/13 [39%] vs 7/99 [7%], P = .005). Operative mortality (within 30 days) also tended to be increased statistically nonsignificantly (2/13 [15%] vs 6/99 [6%], P = .2). Salvage esophagectomy resultedin long-term survival (25% 5−year survival) in a subset of patients. Improved survival after salvage esophagectomy was associated with early pathologic stage (T1 N0, T2 N0), prolonged time to relapse, and R0 surgical resection.
Conclusion: Patients who undergo salvage esophagectomy for relapse of tumor after definitive chemoradiation therapy have increased morbidity, mortality, and hospital use relative to patients undergoing planned esophagectomy after preoperative chemoradiation. Nevertheless,long-term survival can be achieved in this group, and such treatment should be considered for carefully selected patients at an experienced center.
Methods: We reviewed our experience with salvage esophagectomy from 1987 to 2000 at M.D. Anderson Cancer Center (n = 13, salvage after chemotherapy and radiotherapy group) and compared the data with those of patients receiving esophagectomy in a planned fashion 4 to 6 weeks after preoperative chemotherapy and radiation therapy (n = 99, preoperative chemotherapy and radiotherapy group).
Results: Increases in morbidity were seen after resection in the salvage after chemotherapy and radiotherapy group relative to the preoperative chemotherapy and radiotherapy group: mechanical ventilation (9.0 days vs 3.3 days, P = .08), intensive care unit stay (11.2 days vs 5.1 days, P = .07), hospital stay (29.4 days vs 18.4 days, P = .03), and anastomotic leak rates (5/13 [39%] vs 7/99 [7%], P = .005). Operative mortality (within 30 days) also tended to be increased statistically nonsignificantly (2/13 [15%] vs 6/99 [6%], P = .2). Salvage esophagectomy resulted
Conclusion: Patients who undergo salvage esophagectomy for relapse of tumor after definitive chemoradiation therapy have increased morbidity, mortality, and hospital use relative to patients undergoing planned esophagectomy after preoperative chemoradiation. Nevertheless,
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Почечная недостаточность.
Патологическое состояние, характеризующееся нарушением почечной регуляции химического гомеостава организма с частичным или полным нарушением образования и (или) выделения мочи.
