对于接受放化疗 (CRT) 的局部晚期食管癌患者，放射学评估的局限性可能需要手术探查以确定疾病的可切除性。术中确认 T4b 疾病 (sT4b) 后，最佳治疗策略仍不清楚。虽然一些外科医生可能会选择不切除，但其他外科医生则主张姑息性食管切除术（PE）。遗憾的是，目前的文献并未就处理这些复杂病例的最有效方法达成共识。研究队列由 68 名在 CRT 后出现 sT4b 疾病的食管鳞状细胞癌 (ESCC) 患者组成。对接受 PE 的患者 (n = 56) 和接受开闭 (OC) 手术的患者 (n = 12) 的围手术期结果和总生存期 (OS) 进行比较。接受 OC 手术的患者住院时间较短（16.5 天 vs. 28.8 天；p = 0.052），主要并发症发生率（33.9% vs. 25%；p = 0.549）和院内死亡率（0% vs. 5.4%；p = 0.549）没有显着降低。 = 0.412）比接受 PE 的人高；然而，与 OC 相比，PE 与更高的 2 年 OS 率相关（9.6% vs. 0%；p = 0.009）。在多变量分析中，治疗前临床分期为 II/III（风险比 [HR] 0.51，95% 置信区间 [CI] 0.31-0.87；p = 0.013）和胸骨后重建 PE（HR 0.38，95% CI 0.15-0.49） ; p = 0.010) 与更有利的 OS 独立相关。胸骨后重建的 PE 可能是 CRT 后表现出 sT4b 疾病的 ESCC 患者的可行方法。© 2024。外科肿瘤学会。

In patients with locally advanced esophageal cancer who had undergone chemoradiotherapy (CRT), the limitations of radiological evaluation may necessitate surgical exploration to ascertain disease resectability. Upon intraoperative confirmation of T4b disease (sT4b), the optimal management strategy remains unclear. While some surgeons may opt against resection, others advocate for palliative esophagectomy (PE). Regrettably, the current literature does not provide a consensus on the most effective approach for managing these intricate cases.The study cohort consisted of 68 patients with esophageal squamous cell carcinoma (ESCC) who presented with sT4b disease following CRT. The perioperative outcomes and overall survival (OS) were compared between patients who underwent PE (n = 56) and those who received an open-close (OC) procedure (n = 12).Patients who underwent an OC procedure experienced a shorter hospital stay (16.5 vs. 28.8 days; p = 0.052) and showed a non-significant reduction in the rate of major complications (33.9% vs. 25%; p = 0.549) and in-hospital mortality (0% vs. 5.4%; p = 0.412) than those who received PE; however, PE was associated with a superior 2-year OS rate than OC (9.6% vs. 0%; p = 0.009). In multivariable analysis, a pretreatment clinical stage of II/III (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.31-0.87; p = 0.013) and PE with retrosternal reconstruction (HR 0.38, 95% CI 0.15-0.49; p = 0.010) were independently associated with a more favorable OS.PE with retrosternal reconstruction may be a feasible approach for patients with ESCC exhibiting sT4b disease after CRT.© 2024. Society of Surgical Oncology.