Hagen J A, DeMeester S R, Peters J H, Chandrasoma P, DeMeester T R
Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Los Angeles, CA 90033, USA.
Ann Surg. 2001 Oct;234(4):520-30; discussion 530-1. doi: 10.1097/00000658-200110000-00011.
To document what can be accomplished with surgical resection done according to the classical principles of surgical oncology.
One hundred consecutive patients underwent en bloc esophagectomy for esophageal adenocarcinoma. No patient received pre- or postoperative chemotherapy or radiation therapy. Tumor depth and number and location of involved lymph nodes were recorded. A lymph node ratio was calculated by dividing the number of involved nodes by the total number removed. Follow-up was complete in all patients. The median follow-up of surviving patients was 40 months, with 23 patients surviving 5 years or more.
The overall actuarial survival rate at 5 years was 52%. Survival rates by American Joint Commission on Cancer (AJCC) stage were stage 1 (n = 26), 94%; stage 2a (n = 11), 65%; stage 2b (n = 13), 65%; stage 3 (n = 32), 23%; and stage 4 (n = 18), 27%. Sixteen tumors were confined to the mucosa, 16 to the submucosa, and 13 to the muscularis propria, and 55 were transmural. Tumor depth and the number and ratio of involved nodes were predictors of survival. Metastases to celiac (n = 16) or other distant node sites (n = 26) were not associated with decreased survival. Local recurrence was seen in only one patient. Latent nodal recurrence outside the surgical field occurred in 9 patients and systemic metastases in 31. Tumor depth, the number of involved nodes, and the lymph node ratio were important predictors of systemic recurrence. The surgical death rate was 6%.
Long-term survival from adenocarcinoma of the esophagus can be achieved in more than half the patients who undergo en bloc resection. One third of patients with lymph node involvement survived 5 years. Local control is excellent after en bloc resection. The extent of disease associated with tumors confined to the mucosa and submucosa provides justification for more limited and less morbid resections.
记录按照外科肿瘤学经典原则进行手术切除所能取得的成效。
连续100例患者接受了食管癌整块切除术。无一例患者接受术前或术后化疗或放疗。记录肿瘤深度以及受累淋巴结的数量和位置。通过将受累淋巴结数量除以切除的淋巴结总数来计算淋巴结比率。所有患者均完成随访。存活患者的中位随访时间为40个月，23例患者存活5年或更长时间。
5年总精算生存率为52%。根据美国癌症联合委员会（AJCC）分期的生存率分别为：1期（n = 26），94%；2a期（n = 11），65%；2b期（n = 13），65%；3期（n = 32），23%；4期（n = 18），27%。16例肿瘤局限于黏膜层，16例局限于黏膜下层，13例局限于固有肌层，55例为透壁性肿瘤。肿瘤深度以及受累淋巴结的数量和比率是生存的预测因素。腹腔淋巴结转移（n = 16）或其他远处淋巴结转移（n = 26）与生存率降低无关。仅1例患者出现局部复发。手术区域外有9例患者出现潜在淋巴结复发，31例出现全身转移。肿瘤深度、受累淋巴结数量和淋巴结比率是全身复发的重要预测因素。手术死亡率为6%。
接受整块切除的食管癌患者中，超过半数可实现长期生存。三分之一有淋巴结受累的患者存活了5年。整块切除后局部控制良好。局限于黏膜和黏膜下层的肿瘤所伴发疾病的范围为更有限且创伤更小的切除术提供了依据。
