Nishimaki T, Suzuki T, Kanda T, Obinata I, Komukai S, Hatakeyama K
First Department of Surgery, Niigata University School of Medicine, Japan.
Surgery. 1999 Feb;125(2):142-7.
The purpose of the study was to determine whether extended radical esophagectomy is both clinically and oncologically indicated for patients with superficially invasive esophageal carcinomas.
We reviewed 51 patients with this disease in whom extended radical esophagectomy was performed.
Major morbidity developed in 80% of the patients associated with no mortality after the operation. At surgery lymph node metastases were found in 29 patients (57%). Although the number of positive nodes was 3 or less in 93% of those patients, the tumors metastasized not only to the mediastinal nodes but also to the cervical and abdominal nodes, frequently jumping the first echelon of nodes. The overall 5-year survival rate was 68%. The survival curve of the patients with positive nodes was significantly worse (P < .01) than that of patients with negative nodes: the respective 5-year survival rates were 47% and 93%. However, no significant difference was detected between the survival curves of the patients with cervical metastases and those with noncervical metastases.
Extended radical esophagectomy is needed for complete tumor clearance and may be effective in improving the rate of cure in patients with superficially invasive esophageal carcinoma. However, patients should be selected carefully for the performance of extended radical esophagectomy because this procedure is potentially associated with high morbidity rates.
本研究的目的是确定对于浅表浸润性食管癌患者，扩大根治性食管切除术在临床和肿瘤学方面是否适用。
我们回顾了51例行扩大根治性食管切除术的该疾病患者。
80%的患者出现了严重并发症，术后无死亡病例。手术时发现29例患者（57%）有淋巴结转移。尽管这些患者中93%的阳性淋巴结数量为3个或更少，但肿瘤不仅转移至纵隔淋巴结，还转移至颈部和腹部淋巴结，常跨越第一站淋巴结。总体5年生存率为68%。有阳性淋巴结患者的生存曲线明显差于无阳性淋巴结患者（P <.01）：各自的5年生存率分别为47%和93%。然而，有颈部转移患者和无颈部转移患者的生存曲线之间未检测到显著差异。
扩大根治性食管切除术对于完全清除肿瘤是必要的，可能对提高浅表浸润性食管癌患者的治愈率有效。然而，由于该手术可能伴有高发病率，应谨慎选择患者进行扩大根治性食管切除术。
