食管癌（英文）.ppt

Esophageal Cancer and Combined modality Treatment Aruna Kommareddy, M.D. Fellow, Washington University School of Medicine Current AJCC 2002 staging Types of esophagectomies Transhiatal Exposure is provided by an upper midline laparotomy and a left neck incision. The thoracic esophagus is bluntly dissected, and a cervical anastomosis created; thoracotomy is not required. Drawbacks: inability to perform a full thoracic lymphadenectomy, and lack of visualization of the midthoracic dissection. Transthoracic The Ivor Lewis esophagectomy combines a laparotomy with right thoracotomy, and produces an intrathoracic anastomosis. This technique permits direct visualization of the thoracic esophagus, and allows the surgeon to perform a limited lymphadenectomy. However formal dissection of lymph nodes is not performed Types of esophagectomies Three field lymphadenectomy: Widely practiced in Japan En bloc resection of esophagus, azygous vein, thoracic duct, lateral pleural surfaces, part of pericardium Dissection of cervical, mediastinal and upper abdominal nodes with RPLD performed Two field lymphadenectomy: En Bloc resection of esophagus, azygous vein, thoracic duct along with lateral pleural surfaces and part of pericardium and mediastinal nodes and dissection of upper abdominal nodes with RPLD performed Hulscher et al Patterns of disease recurrence post surgery In one study 108 patients had a curative resection for SCC of the thoracic esophagus. At a median follow-up of 20 months: Recurrence : 52 % Mainly extrathoracic recurrence : 41 % Mainly intrathoracic recurrence : 25 % Neoadjuvant /adjuvant therapy Neo-adjuvant Chemotherapy Neo-adjuvant Radiation Neo-adjuvant Chemo-Radiation Adjuvant Chemotherapy Adjuvant Radiation Adjuvant chemoradiation Why Neoadjuvant/Adjuvant therapy In most cases esophageal cancer is a systemic disease at diagnosis. Surgery alone is curative in a small group of patients. Patterns of recurrence suggest both local and systemic failure. D