Neoadjuvant chemoradiotherapy followed by combined thoracoscopic and laparoscopic esophagectomy in the treatment of locally advanced esophageal carcinoma

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Author:
ZHU Cheng-chu(Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Taizhou 317000, China)
CHEN Bao-fu(Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Taizhou 317000, China)
KONG Min(Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Taizhou 317000, China)
WANG Chun-guo(Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Taizhou 317000, China)
WANG Zheng(Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Taizhou 317000, China)
MA De-hua(Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Taizhou 317000, China)
YE Min-hua(Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Taizhou 317000, China)
YE Zhong-rui(Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Taizhou 317000, China)
Journal Title:
Chinese Journal of Gastrointestinal Surgery
Issue:
Volume 15, Issue 09, 2012
DOI:
10.3760/cma.j.issn.1671-0274.2012.09.019
Key Word:
Esophageal neoplasms; Neoadjuvant chemoradiotherapy; Thoracoscopy;Laparoscopy ; Esophagectomy

Abstract: Objective To investigate the feasibility and efficacy of neoadjuvant chemoradiotherapy followed by combined thoracoscopic and laparoscopic esophagectomy (CTLE) in the treatment of advanced esophageal carcinoma.Methods From June 2011 to February 2012,11 patients with locally advanced esophageal carcinoma underwent neoadjuvant chemoradiotherapy followed by CTLE (clinical stage Ⅱ B-ⅢA).NP (vinorelbine pin and cisplatin) or TP (programpaclitaxel-pin and cisplatin) were applied as preoperative chemotherapy.During the same period,conventional fractionated radiotherapy was used with the radiation dose of 40 Gy/20 F.At four to six weeks after CRT,11 patients received three-incision CTLE.Results During chemoradiation,9 patients developed bone marrow suppression.The interval between completion of chemoradiation and surgery was (49.6±15.4) d.Intraoperative findings revealed local fibrosis in one patient (75 days after chemoradiation) while operative difficulty was not increased in the remaining 10 patients.Compared to 15 patients who received surgery alone,operative time was shorter[ (242.3±27.0) min vs.(280.5±27.2) min,P=0.002]and intraoperative blood loss was less[(168.2±95.6) ml vs.(244.5±84.8) ml,P=0.042],the number of removal lymph nodes was similar [ (19.5±5.8) vs.(20.5±7.1),P=0.683 ],postoperative hospital stay was prolonged ](18.9±10.3) d vs.(12.5±4.6) d,P=0.020].The postoperative complication rate was 36.4% including cervical anastomotic leak with pulmonary infection (n=l),cervical anastomotic fistula and hoarseness (n=l),pulmonary infection with pleural effusion (n=2).Follow up ranged from 1 to 9 months,and no recurrence was found.Conclusion The neoadjuvant chemoradiotherapy followed by combined thoracoscopic and laparoscopic esophagectomy in the treatment of locally advanced esophageal carcinoma is safe,feasible,and the short-term outcomes are favorable.

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