Saito R, Suzuki H, Motoyama S, Sasaki S, Okuyama M, Ogawa J, Kitamura M
Second Department of Surgery, Akita University School of Medicine, Japan.
Jpn J Thorac Cardiovasc Surg. 2000 Jul;48(7):417-23. doi: 10.1007/BF03218168.
We studied optimum surgery for carcinoma of the cervical esophagus extending to the thoracic esophagus (Ce-Ut carcinoma).
Subjects were 13 patients diagnosed with Ce-Ut carcinoma treated at our institute from January 1989 to December 1998. Clinicopathologic information such as surgical procedures, pathologic findings, and postoperative complications were analyzed.
In 10, laryngoesophagectomy was conducted due to tracheal invasion by the tumor. In 7, mediastinal tracheostomy was done because of the extended resection of the proximal trachea. In 3, the larynx was preserved and, in 2, cricopharyngeal myotomy was added. Lymph node metastasis was found only in the neck and the upper mediastinum at surgery and recurrences were all lung metastasis. The incidence of postoperative complications was very high (76.9%), and 1 patient died due to widespread tracheal necrosis. The cumulative 5-year survival rate for the group was 33.3% and that for the 9 curative cases was 50%, but most of the cases who underwent noncurative resection and/or who received preoperative therapy for widespread invasion to surrounding organs died within a year.
The prognosis of patients who undergoing curative extended resection of the proximal trachea and suitable lymph node dissection in the neck and upper mediastinum may improve, and larynx-preserving surgery is recommended for patients without tracheal invasion. Despite preoperative chemoradiotherapy, the prognosis of patients with widespread invasion to surrounding organs was very poor, and clinical studies on new therapeutic strategies for these advanced cases are needed to improve the prognosis of Ce-Ut carcinoma patients.
我们研究了颈段食管癌侵犯至胸段食管（颈胸段食管癌，Ce-Ut 癌）的最佳手术方式。
研究对象为 1989 年 1 月至 1998 年 12 月在我院接受治疗的 13 例经诊断为颈胸段食管癌的患者。分析了手术方式、病理结果及术后并发症等临床病理信息。
10 例因肿瘤侵犯气管而行喉食管切除术。7 例因近端气管广泛切除而行纵隔气管造口术。3 例保留了喉，2 例加做了环咽肌切开术。手术时仅在颈部和上纵隔发现淋巴结转移，复发均为肺转移。术后并发症发生率非常高（76.9%），1 例患者因广泛气管坏死死亡。该组患者的 5 年累积生存率为 33.3%，9 例根治性病例的 5 年累积生存率为 50%，但大多数接受非根治性切除和/或因周围器官广泛侵犯而接受术前治疗的病例在 1 年内死亡。
对近端气管进行根治性扩大切除并在颈部和上纵隔进行合适的淋巴结清扫的患者预后可能改善，对于无气管侵犯的患者建议行保喉手术。尽管进行了术前放化疗，但周围器官广泛侵犯的患者预后很差，需要开展针对这些晚期病例的新治疗策略的临床研究以改善颈胸段食管癌患者的预后。
