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선행화학요법을 시행한 식도암 환자의 외과적 고찰
Surgery of Advanced Esophageal Cancer after Chemotherapy

임수빈    (원자력 병원 흉부외과   ); 이종목    (원자력 병원 흉부외과, 삼성의료원 흉부외과  );
  • 초록

    Between June 1988 and June 1994, twenty five patients with locAlly advanced esophageal carcinoma received preoperative chemotherapy (Cisplatln, 5-Fluorouracil with or without Etoposide) and followed by resection. All patients had clinical evidence of airway involvement or distant Iymphnode involve- ment (M 1 Iymphnode) on bronchoscopy or computed tomographic scans. The major response rate to chemotherapy decided by the postoperative stage was 48% (12125). The resection rate was 92% (23/25) with overall complete resection rate of 72% (18125). Two patients had exploratory laparotomy (thorn- cotomy) only. Thirteen patients had esophagogastrostomy with a combined abdominl and Rt. thoracic approach (Ivor Lewis operation), slx pAtients had transhiatal esophagectomy, four patients had esophagogastrostomy with a combined Rt. thoracotonly & abdominal, cervical approach. There were three postoperative deaths (12%). Follow-up duration was between 3.3 months to 65 months. Median survival ime of resected patients except hospital death was 14.8 months. Actuarial survival at 12, 24 months was 72.9%, 26.2%. Signifi- cant better survival was associated with responder group (postoperative stage less than lIB) (P=0.029). These results demonstrate that 1) Preoperative Cisplatin based combined chemotherapy Produce high response rate, 2) High complete resection rate with acceptable mortality rate occur after preoperative chemotherapy, 3) Better surviL dl can be anticipated if complete resection performed after major re- sponse to preoperative chemotherapy.


  • 주제어

    esophageal neoplasm .   chemo therapy.  

  • 참고문헌 (12)

    1. Preoperative therapy for esophageal cancer: A randomized comparison chemotherapy versus radiation therapy , Kelsen,D.P.;Minsky,B.;Smith,M.(et al.) , J Clin Oncol / v.8,pp.1352-1361,
    2. 식도암 환자의 수술전 평가에서 기관지내시경의 역할 , 김봉석;김서운;이영현(등) , 대한내과학회지 / v.46,pp.521-527,
    3. 식도암치료의 임상적 고찰 , 심영목;조재일;김효윤;박승준 , 제25차 흉부외과학회 초록집 / v.,pp.55,
    4. Preliminary results with neoadjuvant therapy for esophageal carcinoma , Hoff,S.J.;Stewart,J.R.;Sawyer,J.(et al.) , Ann Thorac Surg / v.56,pp.282-287,
    5. Preoperative chemotherapy followed by surgery with possible postoperative radiotherapy in squamous call carcinoma of the esophagus : Evaluation of the chemotherapy component , Carey,R.W.;Hilgenberg,A.D.;Wilkins,E.W.(et al.) , J Clin Oncol / v.4,pp.697-701,
    6. Cisplatin-Bleomycin in the treatment of esophageal carcinoma: A final report , Coonley,C.;Bains,M.;Kelsen,D.P.(et al.) , Cancer / v.54,pp.2351-2355,
    7. Preoperative chemotherapy and radiation therapy for patients with cancer of the esophagus: A potentially curative approach , Leichman,L.;Steiger,Z.;Seydel,H.G.(et al.) , J Clin Oncol / v.2,pp.75-79,
    8. Cisplatin and 5-fluorouracil in the primary management of squamous esophageal cancer , Kies,M.S.;Rosen,S.T.;Tsang,T.K.(et al.) , Cancer / v.60,pp.2156-2160,
    9. Evaluation of pre- and postoperative chemotherapy for resectable adenocarcinoma of the esophagus or gastroesophageal junction , Ajani,J.A.;Rith,J.A.;Ryan,B.(et al.) , J Clin Oncol / v.8,pp.1231-1238,
    10. Cisplatin,vindesine and bleomycin chemotherapy of local-regional and advanced esophageal carcinoma , Kelsen,D.P.;Coonley,C.;Hilaris,B.(et al.) , Am J Med / v.75,pp.645-652,
    11. Preoperative chemotherapy, surgical resection, and selective postoperative therapy for squamous cell carcinoma of the esophagus , Hilgenberg,A.D.;Carey,R.W.;Wilkins,E.W.(et al.) , Ann Thorac Surg / v.45,pp.357-363,
    12. Patients of treatment failure and prognostic factors associated with the treatment of esophageal carcinoma with chemotherapy and radiotherapy either as sols treatment or followed by surgery , Gill,P.C.;Denham,J.W.;Jamieson,G.G.(et al.) , J Clin Oncol / v.10,pp.1037-1043,

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