ObjectiveTo investigate the clinical characteristics of thoracic esophageal-gastric cancer (TEGC) and the safety and effectiveness of secondary reconstruction of thoracic and gastrointestinal tract after esophageal and preventriculus cancer (esophagogastric junction) surgery.MethodsThe clinical data of 353 patients with esophageal and preventriculus cancer who underwent endoscopic review from July 2007 to December 2019 were retrospectively analyzed. A total of 31 (8.78%) patients with relapsed or recurrent TEGC were found, including 24 males and 7 females with a mean age of 58.5 years (range: 42 to 68 years). There were 18 (58.06%) patients of adenocarcinoma and 13 (41.94%) squamous cell carcinoma. All patients underwent TEGC resection and secondary reconstruction of thoracic gastrointestinal tract. Thoracoabdominal computed tomography (CT) and upper gastrointestinal imaging (GI) were performed during follow-up, and gastroscopy was performed for suspected patients. All the patients were followed-up till death or December 30, 2019. The survival rate was calculated by Kaplan-Meier method, and the survival was analyzed using the log-rank test. ResultsThirty-one patients underwent thoracic esophagectomy and gastric cancer resection, and then reconstruction of the thoracic and gastrointestinal tract. Eight patients underwent residual gastroesophageal thoracic anastomosis, 13 patients colon esophagectomy, 6 patients jejunal esophagectomy (1 patient esophago-jejunal Roux-en-Y anastomosis), and 4 patients cervical esophagogastric anastomosis. The mean operation time and intraoperative blood loss were 404.8 (340-475) min and 378.4 (180-620) mL. The postoperative complications ocurred in 4 patients, including 3 patients of pulmonary infection and 1 patient of cervical incision infection. The mean hospital stay was 17.1 (14-21) d. All patients were followed up, the median survival time of 11 patients in stage Ⅰ-ⅡA was 25 (19.8-35.0) months and 20 patients in stage ⅡB-ⅢA was 16 (12.5-19.5) months. There was a significant difference between the two groups (χ2=7.840 8, P<0.01).ConclusionPostoperative relapsed and recurrent TEGC occurs after the surgery for esophageal and preventriculus cancers, most of which are caused by metachronous gastric cancer or residual esophageal carcinoma recurrence which leads to invasion of the thoracic and gastric wall. Regular endoscopic review is the main method after operation. It is technically safe and feasible to reconstruct the thoracic and esophageal digestive tract in patients with TEGC after reoperation, which can benefit the survival of patients.
目的总结针对局部进展期非小细胞肺癌（LA-NSCLC）施行肺癌扩大指征手术的临床经验。 方法回顾性分析2008年1月至2012年12月同济大学附属东方医院胸心外科非计划性实施肺癌扩大指征手术治疗的14例LA-NSCLC患者的临床资料，其中男9例、女5例，年龄30～67（59.5±6.1）岁。行胸壁切除与重建术2例，主动脉切除及重建术1例，肺癌上腔静脉切除重建术3例，椎体部分切除术1例，左心房部分切除术1例，肺上沟瘤外科治疗2例，袖形全肺切除或肺叶切除隆突成形术3例，支气管肺动脉成形术1例。 结果本组患者无围手术期死亡病例。术后病理诊断鳞癌7例，腺癌4例，鳞腺癌1例，腺样囊性癌2例。随访18.5（7～48）个月。全组患者中术后生存时间最长者超过4年；3例分别于术后7个月、11个月和17个月死于肿瘤远处转移；1例存活26个月，1例存活20个月，另1例术后3个月并发肺部感染死亡；4例已存活3年以上；另有3例术后随访至2013年9月，随访时间未满1年仍存活。 结论肺癌扩大指征手术能使LA-NSCLC患者获得肺癌的完全性切除，其中相当部分患者术后可获良好的近远期效果，因此外科治疗依旧是肺癌治疗的基石，对有条件手术者应力争手术治疗。