Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
World J Surg. 2011 Jun;35(6):1311-20. doi: 10.1007/s00268-011-1069-8.
We have compared the oncologic effectiveness of limited resection (LR) techniques such as transhiatal (TH) or limited resection of the esophagogastric junction with intestinal interposition (LREGJ) in the treatment of early esophageal carcinoma with that of the extended resection such as the classical thoracoabdominal (TA) en bloc esophagectomy.
We performed a retrospective analysis of prospectively collected data of 113 patients with T1 esophageal cancer (57 adeno- and 56 squamous cell carcinomas) who had surgical resection with systematic lymphadenectomy. Forty-one underwent extensive (TA) and 72 limited resection (51 TH and 21 LREGJ).
Complete resection (R0) was achieved in all cases. Lymphatic metastases were seen in none of the mucosal but in 26.8% of the submucosal T1 cancers. The median lymph node yield was significantly higher in patients with extensive resection (24 vs. 15 lymph nodes; p=0.036), but this did not affect the overall survival (median=88 vs. 102 months, 5-year survival probability=57.8 vs. 67.7%; log rank=0.578). The median hospital stay and ICU stay were significantly shorter in the LR group (p=0.039 and p = 0.044, respectively).
Limited resection leads to lower lymph node yield but similar oncologic effectiveness as the extensive surgery. It may represent a valuable alternative in the treatment of patients with early (submucosal) esophageal carcinoma.
我们比较了有限切除术（LR）技术，如经食管裂孔（TH）或食管胃交界有限切除术伴肠间置术（LREGJ），与经典胸腹联合（TA）整块食管切除术等广泛切除术在治疗早期食管癌方面的肿瘤学效果。
我们对 113 例 T1 食管癌（57 例腺癌和 56 例鳞癌）患者的前瞻性收集数据进行了回顾性分析，这些患者均接受了系统性淋巴结清扫的手术切除。41 例患者接受广泛（TA）切除术，72 例患者接受有限切除术（51 例 TH 和 21 例 LREGJ）。
所有病例均达到完全切除（R0）。黏膜 T1 癌无一例发生淋巴转移，但 26.8%的黏膜下 T1 癌发生淋巴转移。广泛切除组的淋巴结检出中位数明显更高（24 个 vs. 15 个淋巴结；p=0.036），但这并未影响总体生存率（中位数=88 个月 vs. 102 个月，5 年生存率概率=57.8% vs. 67.7%；log rank=0.578）。LR 组的中位住院时间和 ICU 停留时间明显缩短（p=0.039 和 p=0.044）。
有限切除术导致淋巴结检出量较低，但与广泛手术相比具有相似的肿瘤学效果。它可能是治疗早期（黏膜下）食管癌患者的一种有价值的替代方法。
