Tabira Yoichi, Okuma Toshitada, Sakaguchi Tomonori, Kuhara Hiroshi, Teshima Kenichi, Kawasuji Michio
Department of Surgery I, Kumamoto University School of Medicine, Japan.
Hepatogastroenterology. 2004 Jul-Aug;51(58):1015-20.
BACKGROUND/AIMS: There are no systematic criteria for cervical lymphadenectomy in esophageal carcinoma. We provide a new algorithm for deciding whether to use three-field dissection or two-field dissection.
Ninety-eight patients underwent curative esophagectomies with three-field lymph node dissections for squamous cell carcinoma of the thoracic esophagus. We examined the outcomes and predictors for survival of these patients. Therefore, we devised a new decision tree for deciding whether to use three-field dissection or two-field dissection.
The overall 5-year survival rate for the 98 patients was 41.3%. The number of positive nodes was the only significant predictor for survival in the multivariate Cox proportional hazard model. The outcomes of patients with positive supraclavicular/internal jugular nodes were poor. On the other hand, positive cervical paraesophageal nodes do not worsen prognosis. We provided a new algorithm for selecting procedure of lymphadenectomy based on the presence of lymph node metastases. This algorithm is decided by the number of positive nodes, the presence of cervical node metastasis and recurrent nerve node metastasis. According to this decision tree, there were a few patients who needed absolutely three-field dissections.
The new algorithm may be helpful for deciding three-field dissection or two-field dissection for thoracic esophageal carcinoma.
背景/目的：食管癌颈淋巴结清扫尚无系统标准。我们提供一种新的算法，用于决定是采用三野清扫还是二野清扫。
98例患者因胸段食管鳞状细胞癌接受了根治性食管切除术及三野淋巴结清扫。我们检查了这些患者的预后及生存预测因素。因此，我们设计了一种新的决策树，用于决定是采用三野清扫还是二野清扫。
98例患者的总体5年生存率为41.3%。在多变量Cox比例风险模型中，阳性淋巴结数量是唯一显著的生存预测因素。锁骨上/颈内静脉淋巴结阳性患者的预后较差。另一方面，食管旁颈淋巴结阳性并不会使预后恶化。我们基于淋巴结转移情况提供了一种新的淋巴结清扫术式选择算法。该算法由阳性淋巴结数量、颈淋巴结转移情况及喉返神经淋巴结转移情况决定。根据此决策树，只有少数患者绝对需要进行三野清扫。
新算法可能有助于决定胸段食管癌的三野清扫或二野清扫。
