食管癌的外科治疗

download 食管癌的外科治疗

If you can't read please download the document

description

食管癌的外科治疗. 乔玉磊. 概述. 1913 年 Torek 首次报道成功切除下段食管癌,但病人术后遗留一人工外置管。 1938 年 Marshall 和 Adams 完成第一例食管癌切除胸内食管胃直接吻合。 1940 年 4 月我国吴英恺教授进行了第一例食管癌切除,开创了我国食管外科的历史. 外科治疗. 手术相关的死亡发生率下降(由于术前分期水平,病人选择,手术关的支持治疗的发展) 手术策略的选择包括术前分期,根治性切除和姑息性治疗 食管癌分期是最好的生存预测因子 临床分期需结合影像与外科发现. 流行病学. 西方国家并不常见 - PowerPoint PPT Presentation

Transcript of 食管癌的外科治疗

  • 1913Torek1938MarshallAdams19404

  • : 5/100,000 (140/100,000)

    Hu SP. Chin Oncol,11(2):171~174,2001

    Sex135.49150.60132.19101.12101.7869.20

  • 97.6% 1/3 8.8% 1/3 65.9% 1/3 25.3%

    H. Li, British Journal of Surgery 1997; 84: 855-857 60

  • TisT12N090%1%3%

  • 4cm5%8cm

  • 5(45%75%)14535%551%

  • (3FL)(2FL)

  • 91%591.5%

  • 1969197983,783122publications58392941980198876,911130publications

    56 1310

  • John Wong and Simon Y.K. Law HongKong, Queen Mary Hospital

  • TTETHE

    ()5()()Guile19802400TTE30Eartan198087783TTE33Orringer1984100THE617Hegan199330Enbloc40.631Hegan199333THE13.511Orringer1999800THE4.223Visbal2001220I-L25.222.8Hulscher2002TTE4.039Hulscher2002TTE2.029bailey200317779.8

  • DDP5-FUBLMDDPDDPDDP

  • 1983FrimbergerSong

  • PDTPDT1972Roswell Park Memorial 197319791980photofin

  • PDT

  • (Endoscopic Mucosa ResectionEMR:
  • - - - - Nd:YAG5-Fu

  • 5cm3cm5cm

  • X

  • TTETransthoracic esophagectomy THETranshiatal esophagectomy

  • Ivor Lewis

  • Ivor Lewis

  • Transhiatal esophagectomy (THE) 5Ivor Lewis Simon Law, John Wong. World J Surg 2001; 25: 189-195

  • THEOrringerHurley:

  • OrringerTHE

    Orringer, et al. World J. Surg. 2001;25:196-203

  • GW1GF1 Orringer et al2000

  • R0 (complete macroscopic & microscopic removal) stage III 875 stage III 25

  • En bloc Skinner DB. J Thorac Cardiovasc Surg 1983;85:59-71.Logan A. J Thorac Cardiovasc Surg 1963;46:150-161. En bloc183653052Orringer MB,et al. J Thorac Cardiovasc Surg 1993;105:265-276; discussion 276-277.Altorki N, et al. Ann Surg 2001;234:581-587.Lerut T, et al. Ann Surg 1992;216:583-590.

  • En bloc

    Altorki NK, et al.J Thorac Cardiovasc Surg 1997;114:948-955; discussion 955-956.Lerut T, et al. Ann Surg 1992;216:583-590.Hagen JA,et al. J Thorac Cardiovasc Surg 1993;106:850-858;discussion 858-859en blocWill Rogers effectHagenen blocTHEen blocDeMeester TR,et al. J Thorac Cardiovasc Surg 1988;95:42-54.

  • En blocR0R0Law S, et al. World J Surg 2001;25:189-195.Hermanek P. World J Surg 1995;19:184-190.500TTER0529R1R20Ellis FH Jr. Surg Oncol Clin N Am 1999;8:279-294.Orringer MB, et al. J Thorac Cardiovasc Surg 1993;105:265-276; discussion 276-277.en blocAltorki NK, et al. J Thorac Cardiovasc Surg 1997;114:948-955; discussion 955-956.Hagen JA, et al. Ann Surg 2001;234:520-530; discussion 530-531.Altorki N, et al. Ann Surg 2001;234:581-587.

  • a

  • en blok 37

  • Weill-Cornell Mdical College(1998)

  • AJCC

  • 3 (3-FL) Cornell Medical College AND University of Leuven: 1/3 2530 7 Baba et al1994Kato et al1994Nishihira et al1994

  • 1/346.31/327Akiyama H et al. Ann Surg 1994;220:364-372; discussion 372-373

  • 3-FL 50

  • 670205en bloc

  • .

  • Kato H,et al. Ann Thorac Surg 1991;51:931-935.

    Nishihira T, et al Am J Surg 1998;175:47-51

  • Lerut373717Altorki805365 518825

  • 3

    yearNWang 199824271.1%WU BY 19962322.2%

  • VATS Perry Y et alPittsburgh Medical Center2002

  • 1992Peracchia

  • Minimally Invasive EsaphagectomyMIELuketich22219962002

  • MIE

  • 50

  • DDP5-Fu CP Girling et alLancet2002 2040Gy 1147meta Int J Radiat Oncol Biol Phys 1998 1;41(3):579-83

  • DDP5-FU 4060Gy stage IIIII CP

  • 3040Gy23

  • Nakayama6MetaNygaard3205(T1)Huang46:25Launois67SCC40Gy812859.511.5(EORTC):102SCC46:67

  • 3510 10 Surg Gynecol Obstet 1991 Aug;173(2):123-30

  • KasaiTeniere221SCC4555Gy1035Fok130SCCAC3.5Gy/349Gy52.5Gy2046378

  • ;

  • 406501040801828 Roth AndersonDDPVDS4730206.28.6Kelsen703DDP5Fu284214.916.1p0.52Lancet2DDP80mg/m29026054%p
  • 24

  • 3553P0.06

  • N=258

    DDP/VDS2

    : 44%

    : 42% Chest 1993 Jul;104(1):203-7

  • 5

  • 55852025

  • Jones45Gy5Fu41364523p0.13p0.007Wayne State University (Detroit, MI)LeichmanSCC5FuDDP30Gy37147272418Southwest Oncology Group (SWOG)8037 trial11330Gy71113164THEForastiereACSCC44Gy22DDP/5Fu904031.32585878

  • 6

  • Urba100DDP20mg/m21517211mg/m214172145Gy21.5GyTHE1.461.48241365.21.411.461939p0.0433215p0.07p0.04Walsh113AC25Fu15mg/m2/24h15DDP75mg/m272.67Gy40Gy81611P0013326p0.01936EORTCBosset282SCC3.7Gy2DDP80mg/m2023402819336

  • 3412141/32530PCR7075

  • Adelstein DJ, et al.Proc Am Soc Clin Oncol 1996;15:203a.Raoul JL,et al. Int J Radiat Oncol Biol Phys 1998;42:29-34.Adelstein DJ,et al. Cancer 1997;80:1011-1020.Stahl M, et al.. J Clin Oncol 1996;14:829-837.Nguyen NP, et al. Am J Clin Oncol 2002;25:358-364.Raoul JL,et al. Int J Radiat Oncol Biol Phys 1998;42:29-34.Jones DR,et al. Ann Thorac Surg 1997;64:185-191; discussion 191-192.Forastiere AA, et al. Cancer J Sci Am 1997;3:144-152.Stahl M, et al.. J Clin Oncol 1996;14:829-837 Bates BA, et al. J Clin Oncol 1996;14:156-163.Gaspar LE, et al. (Radiation Therapy Oncology Group Study 9207): final report. Cancer 2000;88:988-995.

  • 6070BLMMMC5-5-FU(ADM)(MTX)(VP-16)15%BLMMMC5-FU80DDP7DDP650~120 mg/m23~421%1120mg/m22d1d151573%NVBEORTC20%DDP32%5%IFO161DDP

  • 5-FUDDPDDP5- FU25%~35%DDPDDP5-FU9218%DDP+5-FU36%DDP+5-FU16%DDP+5-FUCFFAMTXADM+MTX+5-FUELFVP-16+CF+5-FU10%~20%85-FU DDP

  • G2/M Ajani[11]PTX250 mg/m231245032%17PTXVan der Gaast[12]PTX 100~160mg/m2DDP60mg/m23155%Ilson [13]PTX175mg/m23d1DDP 20mg/m2d1-55-FU1g/m2 d1-52116148%5.7, 10.846%30PTX 175mg/m2 d1DDP 40mg/m2 d2d321157.1%517.9%1139.3%PTX+ DDP5-FU

  • DDP4015250mg/m221DDP50mg/m214van der Gaast A, et al. Br J Cancer 1999;80:1052-1057.van der Gaast A, et al. Proc Am Soc Clin Oncol 1999;18:303a.TP47200mg/m224DDP75mg/m22Philip PA, et al.. Semin Oncol 1997;24(suppl 19):S19-86-S19-88.

  • Bains Memorial Sloan Kettering230mg/m2 weekly3080mg/m250.4Gy275mg/m2175mg/m241369235/3835103/43692233922533 Bains MS, et al. J Thorac Cardiovasc Surg 2002;124:270-277.

  • Fox2960Gy5Fu200225mg/2/d25405060mg/m2/week1DDP25mg/m2/week4175mg/m2 over 3hour+DDP(75mg/m2 every 3 weeks) TP462750mg/m2 over 1 hour weeklyDDP25mg/m2 over 1 hour weekly5Fu200mg/m2/d60Gy224182052630341045Goldberg M, et al. http://www.asco.org/ac/1,1003,_12-002489-00_18-002002-00_19-00612,00.asp, accessed 01/11/03.

  • OXPDDP5750mg/m2DDPOXP255FuOXP5FuRosewell ParkKhushalani1OXP5Fu2341111OXP85mg/m2115295Fu180mg/m2/24hour351.8Gy/288 12243OXP5Fu

  • 2a2a5FuKelsen D, et al. J Clin Oncol 1992;10:269-274.Wadler S, et al. Cancer 1993;71:1726-1730.Ilson50DDP5FuIlson DH, et al. Cancer 1995;75:2197-2202.SCCAC

  • CPT-11CPT-112CPT-11125mg/m2/wk-15%2CPT-11CF5-FU11322%CPT-11DDPIlsonCPT-11 65mg/m2DDP 30mg/m214257%Govindan[15]CPT-11 160mg/m260mg/m2 3130%71%443%CPT-11

  • ECOG1201 2/DDP/165mg/m2DDP30mg/m218222945Gy465mg/m2DDP30mg/m218 32DDP30mg/m250mg/m2181522294DDP75mg/m2175mg/m2133DDP/5Fu/

  • GEMKroepGEM 800mg/m2d2d9d16DDP 50mg/m2d1d82813641%29.8GEMDDP

  • DDP/5FuOXP