Kajiyama Y, Tsurumaru M
Department of Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Kyobu Geka. 2005 Jul;58(8 Suppl):756-61.
Esophageal cancer has a fulminant biological characteristic, and shows a higher rate of lymph node metastasis than other gastrointestinal malignancies. The distribution of lymphatic spread is wide from cervical to abdominal field, and 3-field lymph node dissection is a standard procedure in esophageal cancer surgery. However, the morbidity and mortality rate following esophageal resection is higher than that of other gastrointestinal or thoracic surgery. The most serious postoperative complication of esophageal surgery in elderly patients is a pulmonary problem. In order to reduce postoperative pulmonary complications, we try to preserve bronchial artery, pulmonary branches of the vagal nerve, in addition to definite preservation of bilateral recurrent laryngeal nerve. Our survival rate and mean survival period in elderly patients with esophageal cancer was fairly good. To achieve a high survival rate and reduce postoperative morbidity and mortality in elderly patients, preoperative assessment of pulmonary function and quality control of surgical procedure is essential.
食管癌具有迅猛的生物学特性，并且相较于其他胃肠道恶性肿瘤，其淋巴结转移率更高。淋巴扩散的分布范围广泛，从颈部到腹部区域，而三野淋巴结清扫术是食管癌手术的标准术式。然而，食管癌切除术后的发病率和死亡率高于其他胃肠道或胸外科手术。老年患者食管癌手术最严重的术后并发症是肺部问题。为了减少术后肺部并发症，除了明确保留双侧喉返神经外，我们还尝试保留支气管动脉、迷走神经的肺分支。我们治疗老年食管癌患者的生存率和平均生存期相当不错。为了在老年患者中实现高生存率并降低术后发病率和死亡率，术前肺功能评估和手术操作的质量控制至关重要。
