Clinical Trial Of Neoadjuvant Chemotherapy Plus Minimally Invasive Total Mesoesophagus Excision Esophagectomy For Advanced Esophageal Squamous Cell Cancer

Objective:To evaluate the curative effect,feasibility and safety of combined concurrent neoadjuvant chemotherapy followed by Minimally invasive total mesoesophagus excision esophagectomy for treating locally advanced esophageal squamous cell cancer.Methods:This study retrospectively analyzed 190 patients with advanced esophageal squamous cell cancer who were received and cured from March 2013 to August 2015 by the second Department of Thoracic Surgey in Fujian Medical University Union Hospital.In these patients,46 cases in observation group received neoadjuvant chemotherapy with paclitaxel and platinum regimens(TP) for two cycles and followd by surgery.The other 144 cases in matched group were treated with surgery alone during the same period.Operation method of each group was total mesoesophagus excision esophagectomy. The rate of radical resection(R0),the lymph node dissection number,the lymphatic metastasis rate, the lymphatic metastatic incidence,the postoperative morbidity and postoperative survival rate were contrasted between the two groups.Results:The observation group of patients were completed two cycles of neoadjuvant chemotherapy and there were no serious chemical toxicity. Two groups of patients were successfully completed surgical treatment.The radical resection rate was 97.8 % in observation group,and 87.5 % in match group(P=0.042).The lymphatic metastasis rate of the observation group was 52.2% and the rate of the control group was 69.4%(P=0.032). The lymphatic metastasis incidence of the observation group was 5.6% and the incidence of the control group was 7.2%(P=0.023). The radical resection rate,the lymphatic metastasis rate and the lymphatic metastasis incidence of two groups achieve statistical significance.The postoperative morbidity was 34.8% in observation group,and 30.0% in match group(P=0.530), they did not achieve statistical significance. The overall survival rate was 81.8% in observation group,and 71.0% in match group(P=0.158),they did not achieve statistical significance.Conclusions:Neoadjuvant chemotherapy followed by Minimally invasive total mesoesophagus excision esophagectomy for treating locally advanced esophageal squamous cell cancer,compared with surgery alone group,has a good patient tolerance.It has no serious chemotherapy toxicity.It can reduce the lymphatic metastasis rate and the lymphatic metastasis incidence. And it does not increase the postoperative morbidity.It will be hopeful to increase the rate of long-term survival.It is a safe,feasible and effective integrated approach for the treatment of locally advanced esophageal squamous cell cancer.