Ueda Yuji, Shiozaki Atsushi, Itoi Hirosumi, Okamoto Kazuma, Fujiwara Hitoshi, Ichikawa Daisuke, Kikuchi Shojiro, Fuji Nobuaki, Itoh Tsuyoshi, Ochiai Toshiya, Komatsu Shuhei, Yamagishi Hisakazu
Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto 602-8566, Japan.
Oncol Rep. 2006 Nov;16(5):1061-6.
Three-field lymph node dissection has been widely used to treat thoracic esophageal cancer, but is very invasive and can cause serious complications. Whether cervical lymph node dissection should be performed in all patients with thoracic esophageal cancer remains controversial. We pathologically examined the recurrent nerve lymph nodes during surgery in patients with thoracic esophageal cancer to determine the presence or absence of lymph node involvement. In patients without recurrent nerve nodal involvement, cervical lymph node dissection was not performed. Treatment outcomes were analyzed to evaluate whether intraoperative pathological investigation was a useful procedure. Among 71 patients with thoracic esophageal cancer who underwent 3-field lymph node dissection, the rate of cervical lymph node metastasis was 40.9% in patients with recurrent nerve nodal metastasis on intraoperative pathological investigation, as compared with 10.2% in patients without recurrent nerve nodal metastasis (p=0.007). Multiple logistic-regression analysis showed that recurrent nerve nodal metastasis was a strong predictor of cervical lymph node metastasis (odds ratio, 2.98; 95% confidence interval, 1.139-7.775; p=0.03). Among 41 patients who underwent intraoperative pathological investigation, 10 had recurrent nerve nodal metastasis and underwent cervical lymph node dissection. Two of these patients had histological evidence of cervical lymph node metastasis. The remaining 31 patients had no recurrent nerve nodal metastasis on intraoperative pathological examination and therefore did not receive cervical lymph node dissection. None of these patients had cervical lymph node recurrence on follow-up. We compared patients who underwent intraoperative pathological investigation with those who underwent conventional 3-field lymph node dissection (without performing intraoperative pathological investigation). The rates of cervical lymph node recurrence were similar among the groups (2.6% vs. 6.7%), but the 3-year survival rate was significantly higher in the patients who underwent intraoperative pathological dissection (83.3%) than in those who underwent 3-field dissection (57.2%; p<0.05). Although this was a retrospective study, our results suggest that outcomes of patients undergoing cervical lymph node dissection according to the results of intraoperative pathological investigation are at least as good as those in patients undergoing 3-field lymph node dissection. We conclude that intraoperative pathological investigation of recurrent nerve nodal metastasis is useful for determining whether cervical lymph node dissection should be performed in patients with thoracic esophageal cancer.
三野淋巴结清扫术已被广泛用于治疗胸段食管癌，但该手术创伤性很大，且会引发严重并发症。对于所有胸段食管癌患者是否均应行颈部淋巴结清扫术，目前仍存在争议。我们对胸段食管癌患者手术过程中的喉返神经淋巴结进行了病理检查，以确定是否存在淋巴结受累情况。对于喉返神经淋巴结未受累的患者，未行颈部淋巴结清扫术。我们分析了治疗结果，以评估术中病理检查是否是一项有用的操作。在71例行三野淋巴结清扫术的胸段食管癌患者中，术中病理检查显示喉返神经淋巴结转移的患者颈部淋巴结转移率为40.9%，而喉返神经淋巴结未转移的患者颈部淋巴结转移率为10.2%（p=0.007）。多因素逻辑回归分析显示，喉返神经淋巴结转移是颈部淋巴结转移的有力预测指标（比值比为2.98；95%置信区间为1.139 - 7.775；p=0.03）。在41例行术中病理检查的患者中，10例有喉返神经淋巴结转移并接受了颈部淋巴结清扫术。其中2例患者有颈部淋巴结转移的组织学证据。其余31例患者术中病理检查未发现喉返神经淋巴结转移，因此未接受颈部淋巴结清扫术。这些患者在随访中均无颈部淋巴结复发。我们将行术中病理检查的患者与行传统三野淋巴结清扫术（未进行术中病理检查）的患者进行了比较。两组患者的颈部淋巴结复发率相似（2.6%对6.7%），但行术中病理清扫术的患者3年生存率（83.3%）显著高于行三野清扫术的患者（57.2%；p<0.05）。尽管这是一项回顾性研究，但我们的结果表明，根据术中病理检查结果进行颈部淋巴结清扫术的患者的治疗效果至少与行三野淋巴结清扫术的患者相当。我们得出结论，术中对喉返神经淋巴结转移进行病理检查有助于确定胸段食管癌患者是否应行颈部淋巴结清扫术。
