Objective: To evaluate the efficacy of a surgery based multimodal therapy for locally advanced resectable cervical esophageal squamous cell carcinoma, focusing on surgical indications, selection of resection and reconstruction methods, and factors influencing prognosis. Methods: A retrospective analysis was conducted on the clinical data of 117 patients with primary cervical esophageal squamous cell carcinoma treated at Department of Head and Neck Surgery, Shandong Ear-Nose-Throat Hospital from September 2014 to October 2023. The cohort consisted of 93 males and 24 females, aged from 45 to 77 years. There were 35 cases with T1-T2 stage and 82 cases with T3-T4 stage. Gastroscopy screening upon admission identified synchronous middle-inferior esophageal carcinoma in 11 cases and synchronous hypopharyngeal cancer in 4 cases. Treatment regimens were as follows: surgery with postoperative adjuvant radiotherapy in 72 cases; surgery with adjuvant concurrent chemoradiotherapy/radiotherapy plus targeted therapy in 7 cases; neoadjuvant chemotherapy (or with immunotherapy) followed by surgery and postoperative radiotherapy in 7 cases; neoadjuvant concurrent chemoradiotherapy or planned preoperative radiotherapy followed by surgery in 6 cases; and surgery alone or incomplete postoperative radiotherapy in 25 cases. Total laryngectomy was performed in 112 patients, while, 5 patients retained laryngeal function. The main reconstruction methods included free jejunal graft in 26 cases and gastric pull-up with pharyngogastric anastomosis in 91 cases. Among these, one patients underwent free jejunal graft combined with middle and lower esophageal resection, while two patients with gastric pull-up combined with free skin grafts, one patient combined with pectoralis major myocutaneous flaps, and one patient combined with free jejunal grafts reconstruction. Clinical data were analyzed using SPSS 25.0 software. Results: Follow-up was completed until Feb 2025. Eighty seven patients competed 3-year follow-up. Sixty one patients completed 5-year follow-up. The 3-year and 5-year overall survival rates were 65.0% and 50.5% calculated by the Kaplan-Meier method. Fifty patients died during follow-up, among whom 28 (56.0%) patients died from distant metastases. One patient died perioperatively. Major complications included partial gastric necrosis (n=1), vascular thrombosis of the jejunum graft requiring a second jejunal graft reconstruction (n=1) or salvageable gastric pull-up (n=1), pharyngeal fistula (n=10), severe pulmonary infection (n=3), cervical hemorrhage (n=2), pharyngeal fistula leading to pharyngogastric anastomotic stricture (n=2), and pleural effusion (n=5). Multivariate analysis revealed that T3-T4 stage,N2-N3 stage and stage Ⅲ-Ⅳ diseases were independent prognostic factors (all P<0.05). Conclusions: Surgery-based multimodal therapy for cervical esophageal squamous cell carcinoma provides favorable local control and overall survival. Free jejunal graft and gastric pull-up are the most common reliable reconstructive approaches. Multidisciplinary comprehensive treatment is crucial to ensure surgical safety and efficacy. 目的： 分析以手术为主的综合治疗模式在颈段食管癌治疗中的疗效，探讨局部晚期可切除食管癌的手术切除与修复重建方式选择及预后影响因素。 方法： 回顾性分析2014年9月至2023年10月山东省耳鼻喉医院头颈外科手术治疗的117例原发颈段食管鳞癌患者的临床资料，男93例，女24例，年龄45~77岁。T1~T2期35例，T3~T4期82例。入院后胃镜筛查发现同期合并中下段食管癌11例，同期合并下咽癌4例。治疗方式包括：手术+术后辅助放疗72例；手术+术后同步放化疗/放疗+靶向治疗7例；新辅助治疗（化疗/化疗联合免疫）+手术+术后辅助放疗7例；术前单纯放疗/术前同步放化疗+手术6例；单纯手术或术后放疗未完成25例。本组112例行全喉切除术，5例保留喉功能。主要修复方式包括游离空肠移植26例，胃上提代食管术91例。其中1例行颈段食管切除游离空肠移植同期行下段食管切除胃上提修复，胃上提联合游离皮片修复2例、胃上提联合胸大肌肌皮瓣修复及游离空肠移植修复各1例。采用SPSS 25.0软件对临床数据进行分析。 结果： 至2025年2月，随访满3年患者87例，满5年患者61例，Kaplan-Meier法计算3年生存率为65.0%，5年生存率为50.5%。死亡50例患者中远处转移致死者28例，占56.0%。术后围手术期死亡1例。主要并发症包括胃壁部分坏死1例，移植空肠血管栓塞行二次取肠及改为胃上提修复各1例，咽瘘10例，重症肺部感染3例，颈部出血2例，咽瘘后胃咽吻合口狭窄2例，胸腔积液5例。根据多因素分析，T3-T4期、N2-N3、Ⅲ-Ⅳ期晚期病变为影响颈段食管癌患者预后的独立因素（P值均<0.05）。 结论： 以手术为主的颈段食管癌综合治疗可获得较好的肿瘤局部控制率及总生存率，游离空肠移植及胃上提是常用且疗效稳定的修复方式，多学科综合治疗模式是保障手术安全及疗效的关键。.
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PubMed · 2026-03-07
PubMed · 2026-04-07
PubMed · 2026-04-07