食道癌に対する根治的放射線化学療法後の胸腔鏡下サルベージ食道切除術の治療成績

Clinical outcomes of thoracoscopic salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer

◆要旨：根治的放射線化学療法後の胸腔鏡下サルベージ食道切除術の治療成績を検討した．2003年1月～2008年12月の本術式施行22例を対象とした．2例が気管浸潤でR2手術となった．切除可能20例の平均手術時間は333分，出血量は469gであった．縫合不全は7例に，肺炎は2例に発症した．気管壊死はなく，在院死亡例もなかった．8例が再発し，リンパ節4例，血行性3例，播種再発1例であった．1年生存率は78.3％，3年生存率は54.2％で，治療前StageIVの症例の予後は有意に悪かった．胸腔鏡下サルベージ食道切除術は安全に施行可能であるが，縫合不全の発症率が高く再建法に工夫を要すため，本術式の有用性については今後も検討が必要である．

　We examined the clinical outcomes of thoracoscopic salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. We reviwed 22 patients who underwent thoracoscopic salvage esophagectomy from January, 2003 to December, 2008, in our department. Two cases resulted in R 2 surgery because of trachea invasion. The average duration of operation was 333 minutes, and amount of blood loss was 469 g. The most frequent postoperative complication was anastomotic leakage. Leakage developed in seven cases, and pneumonia developed in two cases. There were no cases of trachea necrosis, nor hospital mortality. Recurrent disease was found in eight cases, lymph node recurrence in four, hematogenous recurrence in three, dissemination recurrence in one. A 1-year survival rate was 78.3%, and 3-year survival rate was 54.2%, respectively. The prognosis of the cases with clinical Stage IV before treatment was significantly poor than the other cases. Thoracoscopic salvage esophagectomy can be performed safely, but the incidence of the anastmotic leakage is high. The esophageal reconstruction require's technical improvement in such cases. Further experiences may be needed to clarify the usefulness of this operation.