Igaki H, Kato H, Tachimori Y, Sato H, Daiko H, Nakanishi Y
Department of Surgery, National Cancer Center Hospital and Research Institute, 1-1 Tsukiji 5-chome, Chuo-ku, 104-0045, Tokyo, Japan.
Eur J Cardiothorac Surg. 2001 Jun;19(6):887-93. doi: 10.1016/s1010-7940(01)00701-1.
The efficacy of esophagectomy with three-field lymph node dissection in surgical treatment for patients with squamous cell carcinomas of the lower thoracic esophagus remains controversial. This report documents the outcomes of this surgical procedure for a large series.
From February 1986 to November 1998, 437 patients with squamous cell carcinomas of the thoracic esophagus underwent transthoracic esophagectomy with three-field lymph node dissection. One hundred and sixteen of these had cancer of the lower thoracic esophagus. To avoid the influence of adjuvant therapy on survival, 20 who also received radiation and/or chemotherapy were excluded, leaving 96 patients who were retrospectively analyzed.
The operative morbidity, and 30-day and in-hospital mortality rates were 62, 0, and 3%, respectively. The overall 1-, 3-, and 5-year survival rates were 89, 65, and 59%, with a median survival of 76 months. In those with lymph node metastases (66% of cases), the values were 87, 56, and 48%, as compared with 94, 84, and 79%, respectively (P=0.005) for patients without lymph node metastasis. Factors significantly influencing the overall survival rates were patient age (> or = 65 vs. <65), clinical N status (cN1 vs. cN0), clinical M status (cM1 vs. cM0), longitudinal tumor length of resected specimen (> or =5 vs. <5 cm), pathologic T status (pT3 vs. pT1, 2), pathologic N status (pN1 vs. pN0), lymphatic invasion (positive vs. negative), vascular invasion (positive vs. negative) and intramural metastasis (present vs. absent). Independent prognostic factors for survival determined by multivariate analysis were pathologic T status (P=0.02), pathologic N status (P=0.03), and presence of intramural metastasis (P=0.04). Additional pathologic M1 status, cervical or celiac lymph node metastasis, was without significant influence.
Patients with pathologic T3 tumors with both pathologic N1 status and the presence of intramural metastasis in the lower thoracic esophagus had a poor prognosis. Cervical or celiac lymph node metastasis in patients with carcinomas of the lower thoracic esophagus should be distinguished from pathologic M1 status in the UICC-TNM staging system.
对于胸段下段食管鳞状细胞癌患者，经胸食管切除术加三野淋巴结清扫术的手术疗效仍存在争议。本报告记录了该手术方法用于大量病例的治疗结果。
1986年2月至1998年11月，437例胸段食管鳞状细胞癌患者接受了经胸食管切除术加三野淋巴结清扫术。其中116例为胸段下段食管癌。为避免辅助治疗对生存的影响，排除了20例同时接受放疗和/或化疗的患者，剩余96例患者进行回顾性分析。
手术并发症发生率、30天死亡率和住院死亡率分别为62%、0%和3%。1年、3年和5年总生存率分别为89%、65%和59%，中位生存期为76个月。有淋巴结转移的患者（占病例的66%），其生存率分别为87%、56%和48%，而无淋巴结转移的患者分别为94%、84%和79%（P = 0.005）。显著影响总生存率的因素包括患者年龄（≥65岁与＜65岁）、临床N分期（cN1与cN0）、临床M分期（cM1与cM0）、切除标本的肿瘤纵向长度（≥5 cm与＜5 cm）、病理T分期（pT3与pT1、2）、病理N分期（pN1与pN0）、淋巴管浸润（阳性与阴性）、血管浸润（阳性与阴性）和壁内转移（存在与不存在）。多因素分析确定的独立生存预后因素为病理T分期（P = 0.02）、病理N分期（P = 0.03）和壁内转移的存在（P = 0.04）。额外的病理M1分期、颈部或腹腔淋巴结转移无显著影响。
胸段下段食管病理T3肿瘤伴有病理N1状态和壁内转移的患者预后较差。胸段下段食管癌患者的颈部或腹腔淋巴结转移应与UICC-TNM分期系统中的病理M1状态相区分。
