• 江蘇省中醫(yī)院消化系腫瘤外科（江蘇南京 210029）;

目的 　探討食管胃同時性雙原發(fā)癌的綜合治療方法。
方法 　對2006年10月至2013年2月期間江蘇省中醫(yī)院消化系腫瘤外科診治的8例食管胃同時性雙原發(fā)癌患者的治療過程進(jìn)行分析，探討其綜合治療經(jīng)驗(yàn)。
結(jié)果 　8例食管胃同時性雙原發(fā)癌患者均經(jīng)胃鏡活檢病理學(xué)檢查明確診斷。根據(jù)CT和超聲內(nèi)鏡檢查結(jié)果進(jìn)行術(shù)前分期，T1a期以下的病灶行內(nèi)鏡下黏膜切除6例（食管癌4例，胃癌2例），行手術(shù)切除1例（食管癌）；T2期及以上的病灶行術(shù)前新輔助放化療、手術(shù)、術(shù)后輔助放化療等8例（食管癌2例，胃癌6例），行單純手術(shù)切除1例（食管癌）。8例患者均獲隨訪，隨訪時間為10～76個月，平均41.3個月。1例在術(shù)后7個月死亡，1例在術(shù)后20個月發(fā)現(xiàn)腫瘤轉(zhuǎn)移，余6例患者隨訪期間均無復(fù)發(fā)和轉(zhuǎn)移。
結(jié)論 　應(yīng)根據(jù)食管胃同時性雙原發(fā)癌的不同病情制定個體化治療方案，包括根治性胃食管癌切除術(shù)、內(nèi)鏡下黏膜切除術(shù)、術(shù)前新輔助放化療、術(shù)后化療等，過度追求手術(shù)治療并不能取得理想的效果。

引用本文： 曹勤洪,陳徹,姚學(xué)權(quán),劉福坤. 食管胃同時性雙原發(fā)癌的綜合治療分析（附8例報道）. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(10): 1141-1145. doi: 復(fù)制

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  1. 1. Beech DJ， Madan AK， Aliabadi-Wahle S， et al. Synchronous occurrence of glioblastoma multiforme and esophageal adenocarcinoma[J]. Am Surg， 2003， 69(2)：136-139.
  2. 2. Edge SB， Compton CC. The American joint committee on cancer：the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Ann Surg Oncol， 2010， 17(6)：1471-1474.
  3. 3. Kumagai Y， Kawano T， Nakajima Y， et al. Multiple primary cancers associated with esophageal carcinoma[J]. Surg Today， 2001， 31(10)：872-876.
  4. 4. Bae JS， Lee JH， Ryu KW， et al. Characteristics of synchronous cancers in gastric cancer patients[J]. Cancer Res Treat， 2006， 38(1)：25-29.
  5. 5. Yasumura T， Maruyama T， Kaji S， et al. Complete response in a case of advanced esophageal and gastric double cancer treated by chemotherapy of TS-1 and low-dose cisplatin[J]. Gan To Kagaku Ryoho， 2006， 33(13)：2069-2071.
  6. 6. Yano K， Yamashita T， Chishiki M， et al. Two cases of synchro-nous superficial double cancers in the esophagus and stomach[J].J UOEH， 2002， 24(2)：225-232.
  7. 7. Noguchi H， Naomoto Y， Kondo H， et al. Evaluation of endoscopicmucosal resection for superficial esophageal carcinoma[J]. Surg Laparosc Endosc Percutan Tech， 2000， 10(6)：343-350.
  8. 8. Yokoyama A， Ohmori T， Makuuchi H， et al. Successful screeningfor early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining[J]. Cancer， 1995， 76(6)：928-934.
  9. 9. Kim HS， Lee DK， Baik SK， et al. Endoscopic mucosal resection with a ligation device for early gastric cancer and precancerouslesions：comparison of its therapeutic efficacy with surgical resection[J]. Yonsei Med J， 2000， 41(5)：577-583.
  10. 10. Nishimura Y， Okuno Y， Ono K， et al. External beam radiation therapy with or without high-dose-rate intraluminal brachytherapy for patients with superficial esophageal carcinoma[J]. Cancer， 1999， 86(2)：220-228.
  11. 11. Vallböhmer D， Hölscher AH， DeMeester S， et al. A multicenter study of survival after neoadjuvant radiotherapy/chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer[J]. Ann Surg， 2010， 252(5)：744-749.
  12. 12. Kim TJ， Kim HY， Lee KW， et al. Multimodality assessment ofesophageal cancer：preoperative staging and monitoring of responseto therapy[J]. Radiographics， 2009， 29(2)：403-421.
  13. 13. Bergman JJ. The endoscopic diagnosis and staging of oesophagealadenocarcinoma[J]. Best Pract Res Clin Gastroenterol， 2006， 20(5)：843-866.
  14. 14. Vazquez-Sequeiros E， Norton ID， Clain JE， et al. Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma[J]. Gastrointest Endosc， 2001， 53(7)：751-757.
  15. 15. Vazquez-Sequeiros E， Wiersema MJ， Clain JE， et al. Impact of lymph node staging on therapy of esophageal carcinoma[J]. Gastroenterology， 2003， 125(6)：1626-1635.
  16. 16. Abdalla EK， Pisters PW. Staging and preoperative evaluation of upper gastrointestinal malignancies[J]. Semin Oncol， 2004， 31(4)：513-529.
  17. 17. Kwee RM， Kwee TC. Imaging in local staging of gastric cancer：a systemic review[J]. J Clin Oncol， 2007， 25(15)：2107-2116.
  18. 18. Weber WA， Ott K. Imaging of esophageal and gastric cancer[J]. Semin Oncol， 2004， 31(4)：530-541.
  19. 19. National Comprehensive Cancer Network. NCCN guidlines ver-sion 2[EB/OL]. 2013-04-25. http：//www. nccn. org/professional/physician_gls/pdf/gastric. pdf.
  20. 20. Stahl A， Ott K， Weber WA， et al. FDG PET imaging of locally advanced gastric carcinomas：correlation with endoscopic and histopathological findings[J]. Eur J Nucl Med Mol Imaging， 2003， 30(2)：288-295.
  21. 21. Chen J， Cheong JH， Yun MJ， et al. Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography[J]. Cancer， 2005， 103(11)：2383-2390.
  22. 22. Bentrem D， Gerdes H， Tang L， et al. Clinical correlation of endoscopic ultrasonography with pathologic stage and outcome in patients undergoing curative resection for gastric cancer[J]. Ann Surg Oncol， 2007， 14(6)：1853-1859.
  23. 23. Okada K， Fujisaki J， Kasuga A， et al. Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection[J]. Surg Endosc， 2011， 25(3)：841-848.
  24. 24. Matsumoto Y， Yanai H， Tokiyama H， et al. Endoscopic ultrason-ography for diagnosis of submucosal invasion in early gastric cancer[J]. J Gastroenterol， 2000， 35(5)：326-331.
  25. 25. Tsendsuren T， Jun SM， Mian XH. Usefulness of endoscopic ultr-asonography in preoperative TNM staging of gastric cancer[J]. World J Gastroenterol， 2006， 12(1)：43-47.
  26. 26. Mekky MA， Yamao K， Sawaki A， et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors[J]. Gastrointest Endosc， 2010， 71(6)：913-919.
  27. 27. Sarela AI， Lefkowitz R， Brennan MF， et al. Selection of patients with gastric adenocarcinoma for laparoscopic staging[J]. Am J Surg， 2006， 191(1)：134-138.
  28. 28. Oda I， Saito D， Tada M， et al. A multicenter retrospective study of endoscopic resection for early gastric cancer[J]. GastricCancer， 2006， 9(4)：262-270.
  29. 29. Cao Y， Liao C， Tan A， et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract[J]. Endoscopy， 2009， 41(9)：751-757.
  30. 30. Hoteya S， Iizuka T， Kikuchi D， et al. Benefits of endoscopic submucosal dissection according to size and location of gastric neoplasm， compared with conventional mucosal resection[J]. J Gastroenterol Hepatol， 2009， 24(6)：1102-1106.
  31. 31. Nakamoto S， Sakai Y， Kasanuki J， et al. Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan：a comparative study with endoscopic submucosal dissection[J]. Endoscopy， 2009， 41(9)：746-750.
  32. 32. Watanabe T， Kume K， Taip M， et al. Gastric mucosal cancer smaller than 7 mm can be treated with conventional endoscopic mucosal resection as effectively as with endoscopic submucosal dissection[J]. Hepatogastroenterology， 2010， 57(99-100)：668-673.