Wolff C S, Castillo S F, Larson D R, O'Byrne M M, Fredericksen M, Deschamps C, Allen M S, Zais T G, Romero Y
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Dis Esophagus. 2008;21(4):328-33. doi: 10.1111/j.1442-2050.2007.00785.x.
Lymph node involvement may impact postoperative therapeutic decision-making and prognosis in patients undergoing esophagectomy. This study evaluates which surgical approach yields the most lymph nodes. We undertook a retrospective chart review of esophagectomies performed by six surgeons from April 1994 to February 2004 using a prospective general thoracic surgery database at Mayo Clinic, Rochester, Minnesota, US. Lymph nodes were categorized into one of 17 regions per the American Joint Committee on Cancer, with the total number of lymph nodes, summed over each region, used as the primary outcome. A total of 517 esophagectomies were performed: 68 transhiatal, 392 Ivor Lewis, and 57 extended Ivor Lewis. A mean of 18.7 (SD 8.5) lymph nodes were retrieved with the Ivor Lewis approach as compared to 17.4 (SD 9.2) with the extended Ivor Lewis approach (P = 0.30). Since there was no statistical difference between the number of nodes collected in either Ivor Lewis approach, they were collapsed into one group for comparison with the transhiatal cases. Significantly more lymph nodes were collected with an Ivor Lewis approach (mean 18.5, SD 8.6) than with a transhiatal approach (mean 9.0, SD 5.0, P < 0.001). As expected, more thoracic lymph nodes were retrieved with the Ivor Lewis approach [mean 12.4 (SD 7.0) vs. 4.7 (SD 5.3), P < 0.001]. The Ivor Lewis approach was also superior for retrieval of abdominal nodes [mean 6.1 (SD 5.6) versus 4.3 (SD 4.4), P = 0.01]. More lymph nodes are obtained at esophagectomy with an Ivor Lewis than a transhiatal approach.
淋巴结受累可能会影响接受食管切除术患者的术后治疗决策和预后。本研究评估哪种手术方式能获取最多的淋巴结。我们使用美国明尼苏达州罗切斯特市梅奥诊所的前瞻性普通胸外科数据库，对1994年4月至2004年2月期间由六位外科医生实施的食管切除术进行了回顾性病历审查。根据美国癌症联合委员会的标准，淋巴结被分为17个区域之一，每个区域的淋巴结总数作为主要结局指标。共进行了517例食管切除术：68例经胸食管裂孔切除术、392例Ivor Lewis手术和57例扩大Ivor Lewis手术。Ivor Lewis手术方式平均获取18.7个（标准差8.5）淋巴结，而扩大Ivor Lewis手术方式平均获取17.4个（标准差9.2）淋巴结（P = 0.30）。由于两种Ivor Lewis手术方式获取的淋巴结数量无统计学差异，因此将它们合并为一组与经胸食管裂孔切除术病例进行比较。Ivor Lewis手术方式获取的淋巴结明显多于经胸食管裂孔切除术（平均18.5个，标准差8.6；平均9.0个，标准差5.0，P < 0.001）。正如预期的那样，Ivor Lewis手术方式获取的胸段淋巴结更多[平均12.4个（标准差7.0）对4.7个（标准差5.3），P < 0.001]。Ivor Lewis手术方式在获取腹段淋巴结方面也更具优势[平均6.1个（标准差5.6）对4.3个（标准差4.4），P = 0.01]。与经胸食管裂孔切除术相比，Ivor Lewis手术方式在食管切除术中能获取更多的淋巴结。
