OPPORTUNITIES OF SURGICAL TREATMENT OF COMPLICATED FORMS OF LOCALLY ADVANCED THORACIC ESOPHAGEAL CANCER
Purpose. The aim of the study is to improve treatment outcomes for patients with complicated forms of locally advanced thoracic esophagus cancer.Materials and methods. During the period from 2005 to 2012, 306 patients with thoracic esophagus cancer underwent surgery at Leningrad Regional Oncologic Dispensary. 123 (40%) patients of them had complicated forms of locally advanced thoracic esophagus cancer (CLATEC). 76 patients (60%) of the study group with CLATEC had combined resections of esophagus with the resection of adjacent organs and structures.The post-operative mortality and complications were compared with the same data in the control group of patients who had standard surgery for ‘uncomplicated» esophageal cancer.A standard preoperative workup, included esophagogastroduodenoscopy, roentgenoscopy of the esoph- agus and stomach; contrast- enhanced CT of the chest and abdomen, EUS (endoscopic Ultrasound of the esophagus (with the technical possibility of the manipulation), bronchoscopy, pulmonary function tests, echocardiography, Holter monitoring. The Karnofsky Performance Scale Index and the ECOG Scale of Per- formance Status were used to quantify the functional status of the patients. The ASA score was used to assess anesteriological risks.Results. Postoperative complication rate did not differ significantly between the groups (36% in the stan- dard surgery group vs. 50% in the combined resection group). However, postoperative mortality rate in the group of patients with CLATEC twise as much as the group of patients who underwent standard esophageal resection (15.8% vs. 8.5%). After the postoperative morphological assessment we selected a group of patients with locally advanced tumor that was allegedly associated with paracancerous inflammation; the group re- quired a T- criterion ‘restaging’.Long-term outcomes for patients with CLATEC who underwent combined resections remain unsatisfac- tory: the three-year survival rate is less than 18%. However, in the absence of regional lymph nodes involve- ment, the three-year survival rate is over 60%.Conclusions.All patients with complicated forms of locally advanced thoracic esophageal cancer, who have con- traindications to chemoradiotherapy, should be considered as surgical candidates for combined resections.Combined resections are expedient for surgical treatment of the patients with complicated forms of locally advanced thoracic esophageal cancer, provided reliable tumor growth assessment in cases when the patients are fit for surgery.Short-term outcomes of combined resections in CLATEC are comparable with that of standard esoph- ageal resections, but postoperative mortality in the group of CLATEC patients is much higher.Absence of metastatic involvement of regional lymph nodes is an apparent favorable prognostic factor for patients with complicated forms in locally advanced thoracic esophageal cancer.