Altorki N, Skinner D
Weill Medical College of Cornell University, Department of Cardiothoracic Surgery, New York, New York 10021, USA.
Ann Surg. 2001 Nov;234(5):581-7. doi: 10.1097/00000658-200111000-00001.
To determine the impact of radical node dissection on the recurrence patterns and survival rates of patients with carcinoma of the esophagus.
The role of esophagectomy with radical lymphadenectomy in the treatment of esophageal cancer is controversial. Most centers favor a limited operation with no attempt at nodal clearance. However, disease recurrence and patient survival rates remain dismal with or without preoperative therapy. The authors postulate that a more radical node dissection would reduce local failure rates and enhance survival.
One hundred eleven patients with esophageal cancer underwent en bloc esophagectomy with radical lymph node dissection between 1988 and 1998. In 90% of patients the procedure was applied nonselectively and without any preoperative therapy. Patients were prospectively followed up for recurrence patterns and survival.
The 5-year survival rate including noncancer deaths was 40%. The 5-year survival rates for patients with stage 1, 2A, 2B, 3, and 4 disease were 78%, 72%, 0%, 39%, and 27%, respectively. Forty percent of patients had node-negative disease (5-year survival rate, 75%), and 60% had nodal metastases (5-year survival rate, 26%). Recurrence occurred in 39% of patients and was local in only 8%.
Radical esophagectomy results in superior overall and stage-specific 5-year survival rates. Extensive node dissection has a positive impact on survival rates, particularly in patients with nodal metastases.
确定根治性淋巴结清扫术对食管癌患者复发模式和生存率的影响。
食管癌切除联合根治性淋巴结清扫术在食管癌治疗中的作用存在争议。大多数中心倾向于进行有限的手术，不尝试进行淋巴结清扫。然而，无论有无术前治疗，疾病复发率和患者生存率仍然很低。作者推测，更彻底的淋巴结清扫术将降低局部失败率并提高生存率。
1988年至1998年间，111例食管癌患者接受了食管癌整块切除及根治性淋巴结清扫术。90%的患者接受了非选择性手术，且未进行任何术前治疗。对患者进行前瞻性随访，观察复发模式和生存率。
包括非癌症死亡患者在内的5年生存率为40%。1期、2A期、2B期、3期和4期疾病患者的5年生存率分别为78%、72%、0%、39%和27%。40%的患者淋巴结阴性（5年生存率，75%），60%的患者有淋巴结转移（5年生存率，26%）。39%的患者出现复发，其中仅8%为局部复发。
根治性食管癌切除术可提高总体和各分期的5年生存率。广泛的淋巴结清扫术对生存率有积极影响，尤其是对有淋巴结转移的患者。
