Fujita H, Kakegawa T, Yamana H, Sueyoshi S, Hikita S, Mine T, Tanaka Y, Ishikawa H, Shirouzu K, Mori K, Inoue Y, Tanabe H Y, Kiyokawa K, Tai Y, Inutsuka H
Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka 830-0011, Japan.
World J Surg. 1999 May;23(5):486-91. doi: 10.1007/pl00012336.
To investigate the adequate extent of esophagectomy and lymphadenectomy for an esophageal cancer localized at the cervicothoracic junction, the mortality and morbidity rates, survival rates, and patterns of recurrence were retrospectively analyzed in two groups-14 patients who underwent total esophagectomy with or without laryngectomy and 15 patients who underwent proximal esophagectomy with or without laryngectomy-at Kurume University Hospital from 1981 to 1996. Proximal esophagectomy with or without laryngectomy resulted in a lower hospital mortality rate and better overall survival for patients who underwent curative esophagectomy compared with total esophagectomy with or without laryngectomy. Multivariate analysis indicated that the extent of esophagectomy (total esophagectomy versus proximal esophagectomy) was not a prognostic factor. The incidence of recurrence was not different between the two groups. Lymph node metastasis or recurrence from such esophageal cancers was localized to the neck and upper mediastinum. For an esophageal cancer localized at the cervicothoracic junction, therefore, proximal esophagectomy with or without laryngectomy and with cervical and upper mediastinal lymphadenectomy could be better indicated for preselected patients.
为了研究针对位于颈胸交界处的食管癌进行食管切除术和淋巴结清扫术的合适范围，对两组患者的死亡率、发病率、生存率及复发模式进行了回顾性分析。这两组患者分别为1981年至1996年在久留米大学医院接受了全食管切除术（伴或不伴喉切除术）的14例患者，以及接受了近端食管切除术（伴或不伴喉切除术）的15例患者。与接受全食管切除术（伴或不伴喉切除术）的患者相比，接受根治性食管切除术的患者采用近端食管切除术（伴或不伴喉切除术）可降低医院死亡率并提高总体生存率。多因素分析表明，食管切除术的范围（全食管切除术与近端食管切除术）并非一个预后因素。两组之间的复发率并无差异。此类食管癌的淋巴结转移或复发局限于颈部和上纵隔。因此，对于位于颈胸交界处的食管癌，对于经过预选的患者，采用近端食管切除术（伴或不伴喉切除术）并进行颈部和上纵隔淋巴结清扫术可能更为合适。
