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探讨食管癌根治术后吻合口复发放射治疗的价值。方法 病理确诊为食管癌且术后病理切缘阴性的 6 1例患者根治术后吻合口复发 ,复发时间在术后 3～ 16 1个月 ,中位时间 16个月。单纯吻合口复发 2 7例 ,吻合口复发伴纵隔淋巴结转移 34例。 46例在吻合口复发后接受放射治疗 (放射治疗组 ) ,10例化疗及 5例未治为非放射治疗组。结果 手术后 1、3、5年总生存率分别为88.5 %、31.2 %、19.7% ;复发后 1、3、5年生存率分别为 2 6 .3 %、3 .2 8%、1.6 4%。 >1年复发后的手术后 5年总生存率分别为 0 .0 %、31.4% (P <0 .0 1) ;5年复发后生存率分别为 0 .0 %、8.9% (P =0 .0 4)。单纯吻合口复发手术后 5年总生存率为 33 .3 % ,吻合口复发 +纵隔淋巴结转移手术后 5年总生存率为 5 .9% (P =0 .0 7)。放射治疗组的手术后 5年总生存率为 2 1.7% ,而非放射治疗组则为6 .7% (P =0 .0 2 ) ,且放射治疗组的复发后 1年生存率为 2 8.3% ,而非放射治疗组则为 0 .0 % (P <0 .0 1)。结论 手术后吻合口复发时间及是否接受放射治疗是影响预后的主要因素 ,单纯吻合口复发者的预后优于吻合口复发合并纵隔淋巴结转移者。
To investigate the value of recurrent radiation therapy for anastomotic stoma after radical resection of esophageal cancer. Methods Sixty-one patients with pathologically confirmed esophageal cancer and negative postoperative pathological margins had recurrence of anastomotic stoma after radical resection. The recurrence time ranged from 3 to 16 months after surgery and the median time was 16 months. There were only 27 cases of anastomotic recurrence, 34 cases of anastomotic recurrence with mediastinal lymph node metastasis. Forty-six patients received radiotherapy (radiotherapy group) after recurrence of anastomosis, 10 patients received chemotherapy, and 5 patients did not receive treatment without radiotherapy. Results The overall 1-, 3-, and 5-year survival rates after surgery were 88.5%, 31.2%, and 19.7%, respectively, and the 1-, 3-, and 5-year survival rates after relapse were 26.3%, 3.8%, and 1.64%, respectively. . The 5-year overall survival rate after 1 year of relapse was 0.0% and 31.4%, respectively (P < 0.01); the 5-year survival rate after relapse was 0.0% and 8.9%, respectively (P = 0; .0 4). The 5-year overall survival rate after anastomotic recurrence surgery was 33.3%, and the 5-year overall survival rate after anastomotic recurrence + mediastinal lymph node metastasis was 5.9% (P = 0.07). The 5-year overall survival rate was 21.7% in the radiotherapy group and 6.7% in the non-radiotherapy group (P=0.02), and the 1-year survival rate after radiotherapy was 28.3. % was compared with 0.0% (P < 0.01) in the non-radiotherapy group. Conclusion The recurrence time of postoperative anastomotic stoma and whether or not to receive radiotherapy are the main factors affecting prognosis. The prognosis of simple anastomotic recurrence is better than that of anastomotic recurrence combined with mediastinal lymph node metastasis.