| ObjectiveTo investigate the safety and clinical results of preoperative neoadjuvant therapy(AT)for resectable esophageal cancer synthetically,this paper compares the differences between surgery alone and preoperative adjuvant therapy(AT)combined surgery for resectable esophageal cancer in radical resection,complications,local recurrence,distant metastasis,post-operative indicators and survival.Methods60 patients,diagnosed as resectable esophageal cancer without radio-chemotherapy contraindications and other diseases by thoracic CT,gastroscopy and upper gastrointestinal barium-meal test,and hospitalized in our hospital from July 2010 to July 2013,are selected.The patients in ordered number(1-60)are divided randomly into two groups by the statistic software SPSS21.0:the group of pre-operative AT combined surgery(30 cases)and the group of surgery alone(30 cases).In the group of receiving AT before surgery,there are 18 males and 12 females at the age of 41 to 72,averaged(56.2±9.4)years old.28cases are squamous cell carcinoma(SC)and the rest 2 are adenocarcinoma.They can be also classified into11 in fungus type,7 in medullary type,9 in ulcerative type and 3 in constrictive type.The cases in stage III a,III B and III c are respectively in the number of 9,11 and 10.In addition,5 cases are diagnosed their lesion changes happened in upper thoracic segment,16 in middle and 9 in lower.The group,treated by surgery only,is of 19 males and 11 females at the age of 42 to 72,averaged(57.2±9.3)years old.29 cases are squamous cell carcinoma and the rest one is adenocarcinoma.There are10 in fungus type,8 in medullary type,8 in ulcerative type and 4 in constrictive type.The cases in stage III a,III B and III c are respectively in the number of 8,10 and 12.In addition,6 cases are diagnosed their lesion changes happened in upper thoracic segment,14 in middle and 10 in lower.The patients in preoperative AT group are treated by neoadjuvant chemoradiation(NRCT)and intravenous infusion of Docetaxel(75 mg/m2)+Nedaplatin(80 mg/m2)for 3 weeks as a circle,two circles in total,while the other group(control)received surgery only after routine examination and preoperative preparation.The results evaluation are in reference to RECIST assessment standard:if the patient has no lesion left after treatment,the result is excellent;if the sum of targeted lesions'maximum diameter reduces at least 30%,the result is good;if the sum of the largest diameters reduces by 20%at most or new lesions are found to develop,the result is average;if the sum of the target lesions'maximum diameters increases at least 20%after surgery,the result is poor.We also analyzed operational outcomes statistically by comparing the two groups in intraoperative and post-operative indicators,complications,local recurrence,distant metastasis,1-year,3-year and 5-year survival,according to RECIST postoperative efficacy.ResultsThere is no statistical significance lying in the comparison of gender,age,pathological classification,type,stage,as well as the lesions location.In the preoperative AT group,it turns out to be excellent in 0cases and good in 17 cases.The excellent and good rate is 56.7%(17/30).Meanwhile,the rate of radical resection in study group is 93.3%(28/30)significantly higher than that in the surgery only group of 73.3%(22/30)(P<0.05),and its rate of non-radical resection is 6.7%(2/30)considerably lower than that in the surgery only group of 26.7%(8/30)(P<0.05).In terms of operation time,the preoperative AT group is much shorter than control group conspicuously(P<0.05).The amount of blood loss,the total drainage volume(P<0.05),the metastatic rate of positive lymph nodes after operation(P<0.05),together with the time of thoracic tube retention and hospitalization(P<0.05)are all significantly less than that in surgery only group.The incidence of complications for preoperative AT group is 26.7%(8/30),specifically3 with pulmonary infection,1 with anastomotic leakage,1 with chylothorax,2 with hypoproteinemia and 1in atrial fibrillation,slightly in contrast to the number of 5,1,1,5,2 in the other group with the complication incidence at 46.6%(14/30).It is clear that the complication indicator is not statistically significant(P>0.05).The local recurrence rate,distant metastasis rate of preoperative AT are 16.7%(5/30)and23.3%(7/30),considerably lower than that in control group of 43.3%(13/30)and 46.7%(14/30)respectively(P<0.05).The difference in Overall Survival(OS)(?~2=7.781,P=0.005,RR=3.34)and Event-free Survival(EFS)(?~2=8.085,P=0.004,RR=2.863)are both of statistical significance.ConlusionThe preoperative adjuvant therapy for resectable esophageal cancer proved its clinical efficacy and improvement in radical resection rate,shortening the time on operation,thoracic tube indwelling,hospitalization,blood loss and total drainage volume,and lowering the incidence of complications,positive lymph nodes metastasis,local recurrence as well as distant metastasis.In this paper,patients in study group present tolerance to radio-chemotherapy.Above all,the pre-operative AT for resectable esophageal cancer promotes patients'survival and deserves spreading. |
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