Wu Chang-rong, Xue Heng-chuan, Zhu Zong-hai, Zhang Zhen-bin, Geng Chang-you, Ma Zhen-kai, Guo Yong, Gao Jie
Department of Thoracic Surgery, Yangzhong People's Hospital, Yangzhong, Jiangsu 212200, China.
Zhonghua Zhong Liu Za Zhi. 2009 Aug;31(8):630-3.
To summarize the surgical effect and clinical application value of esophagectomy with extended 2-field lymph node dissection for patients with esophageal carcinoma.
From June 1987 to December 2008, 1690 patients with esophageal cancer underwent esophagectomy with extended 2-field (thoracic and abdominal) dissection of lymph nodes. Patients with the middle and lower thoracic esophageal cancer underwent Ivor-Lewis esophagectomy, and patients with upper thoracic esophageal cancer underwent Akiyama esophagectomy. 2-field (thoracic and abdominal) lymph node metastases information and the 1, 3, 5, 10-year survival rates were analyzed retrospectively.
Lymph node metastases were found in 713 patients. The lymph node metastases rate was 42.2% (713/1690).Thoracic lymph node metastasis rate was 39.3% (665/1690), among which in the right pleural apical para-tracheal triangle was 20.7% (349/1690), in the posterior upper mediastinum was 26.3% (444/1690), in the lower mediastinum was 18.2% (307/1690). Abdominal lymph node metastasis rate was 20.1% (339/1690). THE Postoperative complication rate was 16.4% (278/1690), among which the pulmonary complication rate ranking the first, was 43.6% (136/312). The operative mortality rate was 0.2%. The 1-year, 3-year, 5-year and 10-year survival rates were 88.2% (1388/1574), 63.5% (868/1367), 54.8% (705/1287) and 30.8% (232/754), respectively. The 5-year survival rate in patients without lymph node metastasis was 76.2% (448/588), but that in patients with lymph node metastases was 36.8% (257/669).
The results of this study demonstrated that Ivor-Lewis and Akiyama esophagectomy with two-field lymph node dissection exposes the operation fields clearly and make radical lymphadenectomy thoroughly, especially the lymph nodes in the posterior upper mediastinum around the recurrent laryngeal nerve and in the right pleural apical para-tracheal triangle. It is essential that patients with esophageal carcinoma with lymph node metastases should undergo esophagectomy with extended 2-field dissection of lymph nodes. This can elevate the postoperative 5-year survival rate remarkably.
总结食管癌患者行扩大二野淋巴结清扫食管切除术的手术效果及临床应用价值。
1987年6月至2008年12月，1690例食管癌患者接受了扩大二野（胸段和腹段）淋巴结清扫食管切除术。胸段中下段食管癌患者行Ivor-Lewis食管切除术，胸段上段食管癌患者行秋山食管切除术。回顾性分析二野（胸段和腹段）淋巴结转移情况及1、3、5、10年生存率。
713例患者发现有淋巴结转移。淋巴结转移率为42.2%（713/1690）。胸段淋巴结转移率为39.3%（665/1690），其中右胸膜顶气管旁三角区为20.7%（349/1690），上纵隔后部为26.3%（444/1690），下纵隔为18.2%（307/1690）。腹段淋巴结转移率为20.1%（339/1690）。术后并发症发生率为16.4%（278/1690），其中肺部并发症发生率居首位，为43.6%（136/312）。手术死亡率为0.2%。1年、3年、5年和10年生存率分别为88.2%（1388/1574）、63.5%（868/1367）、54.8%（705/1287）和30.8%（232/754）。无淋巴结转移患者的5年生存率为76.2%（448/588），有淋巴结转移患者的5年生存率为36.8%（257/669）。
本研究结果表明，Ivor-Lewis和秋山食管切除术加二野淋巴结清扫能清晰暴露手术视野，彻底行根治性淋巴结清扫，尤其是喉返神经周围上纵隔后部及右胸膜顶气管旁三角区的淋巴结。食管癌有淋巴结转移的患者行扩大二野淋巴结清扫食管切除术至关重要。这可显著提高术后5年生存率。
