Cancers of the cervical esophagus occur uncommonly, but treatment is remaining a challenging problem and surgery demands special knowledge of abdominal, thoracic, and neck surgery. The primary risk factor is chronic heartburn, leading to a sequence of esophagitis, Barrett's esophagus, reflux esophag...
Cancers of the cervical esophagus occur uncommonly, but treatment is remaining a challenging problem and surgery demands special knowledge of abdominal, thoracic, and neck surgery. The primary risk factor is chronic heartburn, leading to a sequence of esophagitis, Barrett's esophagus, reflux esophagitis and etc. Among the various treatment modalities, Surgery is still a mainstay of treatment. The main aim of surgery is not only oncologically adequate resection but also preservation or restoration of physiologic functions, such as deglutition and phonation. Surgical treatment of cervical esophageal cancer is influenced by special problems arising from tumor factors, patient factors and surgeon factors. Complete clearance of loco-regional disease and prevention of postoperative complications are of particular importance for the improvement of long-term survival in patients with these cancers. So the cervical and thoracic extension of these tumors usually required an extensive lymphadenectomy with primary resection. Radical resection of the primary site almostly include sacrifice of the larynx, but the voice could be rehabilitated with various methods, such as tracheoesophageal prosthesis or tracheoesophageal shunts, etc. Restoration of the esophageal conduit can be performed using gastric or colon interposition, radial forearm free flap or jejunum free flap, etc. Recently, the advances of radiation therapy and chemotherapy will enable less extended resections with greater rates of laryngeal preservation. At initial presentation, up to 50％ to 70％ of patients will have advanced locoregional or distant disease with virtually no chance for cure. Patients with advanced but potentially resectable esophageal cancer are generally treated by surgery with some form of neoadjuvant chemotherapy, radiotherapy, or both, with 5-year survivals in the 20％ to 30％ range. So the significant adverse factors affecting survival should be taken into account to select the candidates for surgery.
Cancers of the cervical esophagus occur uncommonly, but treatment is remaining a challenging problem and surgery demands special knowledge of abdominal, thoracic, and neck surgery. The primary risk factor is chronic heartburn, leading to a sequence of esophagitis, Barrett's esophagus, reflux esophagitis and etc. Among the various treatment modalities, Surgery is still a mainstay of treatment. The main aim of surgery is not only oncologically adequate resection but also preservation or restoration of physiologic functions, such as deglutition and phonation. Surgical treatment of cervical esophageal cancer is influenced by special problems arising from tumor factors, patient factors and surgeon factors. Complete clearance of loco-regional disease and prevention of postoperative complications are of particular importance for the improvement of long-term survival in patients with these cancers. So the cervical and thoracic extension of these tumors usually required an extensive lymphadenectomy with primary resection. Radical resection of the primary site almostly include sacrifice of the larynx, but the voice could be rehabilitated with various methods, such as tracheoesophageal prosthesis or tracheoesophageal shunts, etc. Restoration of the esophageal conduit can be performed using gastric or colon interposition, radial forearm free flap or jejunum free flap, etc. Recently, the advances of radiation therapy and chemotherapy will enable less extended resections with greater rates of laryngeal preservation. At initial presentation, up to 50％ to 70％ of patients will have advanced locoregional or distant disease with virtually no chance for cure. Patients with advanced but potentially resectable esophageal cancer are generally treated by surgery with some form of neoadjuvant chemotherapy, radiotherapy, or both, with 5-year survivals in the 20％ to 30％ range. So the significant adverse factors affecting survival should be taken into account to select the candidates for surgery.
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제안 방법
환자의 나이는 32세에서 86세까지였으며 평균 61세였 다. 병기는 2기 1례, 3기 5례, 4기 20례의 대부분 진행된 병기의 환자였고 치료로 수술만을 시행한 례는 5례, 수술과 수술 후 방사선 치료를 시행한 례는 13 례, 수술전후 방사선 치료를 시행한 례는 3례, 수술 전 항암화학요법과 수술 후 방사선 치료를 시행한 례는 3례, 수술 전 항암화학요법만을 시행한 례는 1례, 항암화학요법과 방사선 치료를 수술 전시행한 례는 1례였다. 원발병소의 치료로 부분 후두, 부분인두적출 술을 시행한 례가 6례, 후두전적출술과 인두부분적 출술을 시행한 례가 6례, 후두인두전적출술을 시행 한 례가 4례, 후두인두전적출술과 함께 경부식도적 출술을 시행한 례가 6례, 후두인두전적출술과 식도 전적출술을 시행한 례가 4례였다.
대상 데이터
한림의 대 강동성심병원이비 인후-두경부외과에서 1995년부터 2002년까지 하인두암과 경부식도암 으로 진단받고 수술을 시행받은 환자는 전체 26명이었다. 26명의 환자 중 남여 비율은 23:3이었다.
성능/효과
재건은 대흉근 피판이 4례, 전완 유리 피판이 10례, 유리공장 피판이 4례, gastric pull-up0] 4례, 일차 봉합이 4례였다. 수술 후 사망은 3례 있었으며 원인은 호흡부전, 창상감염, 경동맥 파열이었다. 수술 후 재발은 전체 9례에 서 있었으며 원발병소의 재발이 4례, 경부림프절 재발이 5례였다.
수술 후 사망은 3례 있었으며 원인은 호흡부전, 창상감염, 경동맥 파열이었다. 수술 후 재발은 전체 9례에 서 있었으며 원발병소의 재발이 4례, 경부림프절 재발이 5례였다. 원격전이는 5례에서 일어났으며 피부 전이 1례, 폐전이 3례, 뇌전이가 1례였다.
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