Özofagus kanserinin tedavisinde cerrahinin yeri

Abstract

1. ÖZET Yüzüncü Yıl Üniversitesi Tıp Fakültesi Göğüs Cerrahisi Kliniğinde 1996-2001 yıllan arasında özofagus kanseri nedeniyle cerrahi tedavi uygulanan toplam 61 olgu retrospektif olarak değerlendirildi. Olguların 30'u erkek (%49.1), 31'i (%50.8) bayan olup, yaşlan 27-81 (ortalama 50.00 +12.08) arasında değişmekteydi. En sık semptom yutma güçlüğü (%96.8) olup, bunu kilo kaybı(%65) ve göğüs-sırt ağnlan, epigastrik ağn (%49.1) takip etmekteydi. Histopatolojik sımtlandırmada 50 olgu(%81.9) yassı hücreli karsinom, 9 olgu (%14.7) adenokarsinomaydı. 61 olgunun 13 'üne transtorasik özofajektomi + servikal elle anastomoz, 10'una transtorasik özofajektomi ve intratorasik elle anastomoz, 26'sma da transtorasik özofajektomiyi takiben staplerle intratorasik anastomoz uygulandı. 2 olguya transhiatal özofajektomi yapıldı. 1 olguya özofagojejunostomi, 50 olguya özofagogastrostomi yapılırken inrezektabl 10 olgudan l'ine gastrostomi açıldı. Erken postoperatif komplikasyonlardan plevral effüzyon, intratorasik anastomozlu 1 1 olguda, servikal anastomozlu 3 olguda gelişti (p>0.05). Geç komplikasyonlardan GİS komplikasyonlan intratorasik anastomozlu 1 1 olguda, servikal anastomozlu 2 olguda ortaya çıkarken; stenoz ise servikal anastomozlu 2 olguda ortaya çıktı (p<0.05). Olgulann %13.1'inde fistül gelişti ve fistül gelişenlerde mortalite %75 oldu. Servikal anastomozlu 3 fistül vakasından l'i (%33.3) öldü. Stapler anastomozlu olgularda mortalite %9.8 iken, elle anastomozlu olgularda %13.1 oldu. En sık mortalite sebebi fistül ve solunum sistemi komplikasyonlan idi. Ortalama yaşam 16.02 ± 10.50 ay ve 1 yıllık sağkalım %51, 2 yıllık sağkalım %25, 3 yıllık sağkalım ise %10 olarak tesbit edildi. Uygulanan cerrahi yöntemlerin sağkalım üzerine anlamlı bir etkisinin olmadığı görüldü. Bizim olgularda da gözlemlediğimiz gibi özellikle erken evre kanserlerde cerrahi tedavi tek seçenek olmakla beraber, lokal-lökorejyonel hastalığı bulunan ileri evre hastalarda cerrahi tedavi, kemoterapi, radyoterapinin multimodal bir tedavi seçeneği halinde kombine uygulanması sağkalım üzerinde önemli derecede olumlu etki yapmaktadır.

2. SUMMARY In this study, a total 61 cases were retrospectively evaluated after their referrals to the clinic of Chest Surgery in Yüzüncü Yıl University during the period between 1996 and 2001 due to esophagial cancer and thus having undergone surgical treatment. 30 of our cases were men (49.1%) and 31 of them were women (50.8%); the age changed between 27-81 and the mean (50.00±12.08).The most - frequently observed symptom was dysphagia 96.8%, weight loss 65%, thoracic and back pains as well as epigastric pains 49.1%. In the hystopathologically examination 50 cases (81.9%) were detected to have squamous cell carcinoma and 9 of them (14.7%) had adenocarcinoma. Of the 61 cases 13 of them underwent transthoracic esophagogastrectomy+ cervical anastomosis manually, 10 of them transthoracic esophagectomy and manually intrathoracic anastomosis. Transhiatal esophagectomy was applied to 2 cases and esophagojejunostomy to 1 case. Whereas 50 cases were applied to esophagogastrostomy, 1 in 10 cases was given gastrostomy inresectably. Pleural effusion which is a postoperative complication in the early stages developed in 1 1 of the patients who had intrathoracic anastomosis and 3 patients who had cervical (p>0.05). The complications of gastrointestinally system which are observed in the later stages developed in 11 patients with intrathoracic anastomosis and 2 patients with cervical anastomosis, whereas stenosis appeared in 2 patients with cervical anastomosis (p<0.05). Fistula developed in 13.1%of the cases and mortality rate of such cases were found as 75%. Of the 3 fistula cases having cervical anastomosis died (33.3%). Whereas mortality rate in cases with stapler anastomosis were found as 9.8%, in cases with manual anastomosis this rate was found as 13.1%. The most frequent mortality causes were fistula and respiratuary system complications. The average survival was found as 16.02±10.50 mounth and 1 year of survival was found as 51.2%; 2 years of survival was 25.3%; 3 years of survival was 10%. The surgical treatments applied to the cases weren't found to have a statistically significant effect on the survivability. Throughout the course of our study, we came to the conclusion that surgical treatment would be recommended to the patients with local and locoregional conditions in the advanced stages if it is applied in combination with chemotherapy and