Authors
Sadovskaia K.V.1, Shostka K.G.2, Ter-Ovanesov M.D.3, Kuznetsov I.M.2, Kucherenko A.D.2, Sigua B.V.1
1 Almazov National Medical Research Centre, Saint-Petersburg
2 Military Medical Academy named after SM Kirov, Saint-Petersburg
3 Russian University of Medicine, Moscow
Abstract
Backgraund. Esophageal cancer ranks ninth among the most common human malignancies in the world. Treatment of patients with thoracic esophageal cancer remains one of the most challenging tasks of clinical oncology.
The preferred method of treatment is neoadjuvant (or perioperative) therapy followed by esophagectomy, with a 5-year survival rate of 40–50%. The low sensitivity of esophageal cancer to existing conservative therapy makes surgery the main method of treatment for patients with this disease. Surgical treatment of malignant esophageal tumors cannot be called standardized, as many technical details may differ between surgeons, centers, and countries. The probability of unreliable assessment of the tumor process prevalence increases in case of complicated esophageal cancer. Thus, paracancrotic inflammation with involvement of adjacent anatomical structures significantly complicates intraoperative diagnosis, which leads either to unjustified combined operations or to unjustified reduction of the operation volume to palliative.
Aims. To study topographo-anatomical features in patients with complicated locally advanced esophageal cancer in order to increase the reliability of intraoperative revision data and, as a consequence, to increase the performance of radical operations and reduce the number of palliative (R-1, R-2) resections.
Materials and methods. From 2005 to 2013, 343 patients were operated on for intrathoracic esophageal cancer at the Leningrad Regional Oncologic Dispensary. Of these, 140 patients (40.8%) had complicated locally advanced esophageal cancer (LECECEC). A total of 273 patients were included in the study. Postoperative complications and mortality were categorized into surgical and non-surgical complications.
Results. In the group of patients with OMRRP, 82 patients (58.6%) underwent combined operations; 58 patients (41.4%) underwent symptomatic surgical interventions (endoscopic stent placement in the area of tumor stricture, gastrostomy formation). The study included patients who underwent standard esophageal resections (133 observations) and were considered as a control group.
Conclusions. Patients with complicated forms of locally advanced thoracic esophageal cancer, in the absence of distant metastases and contraindications to chemoradiotherapy and neoadjuvant chemotherapy, should be considered as candidates for combined operations. Taking into account topographo-anatomical features of complicated forms of locally advanced esophageal cancer, reliable intraoperative assessment of resectability of esophageal tumor using special techniques is an important factor allowing to increase the number of radical operations and reduce the number of palliative resections and symptomatic operations. The immediate results of combined operations are comparable to those of standard esophageal resections.
Keywords: topographic-anatomical features of complicated locally advanced esophageal cancer, topographic anatomy of the esophagus, combined resections for esophageal cancer, esophageal surgeries with resection of neighboring structures and organs.
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