Fang Qiang, Han Yong-tao, Wang Shao-xin, Ren Guang-guo, Peng Lin, Xiao Wen-guang, Chen Li-hua
Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China.
Zhonghua Zhong Liu Za Zhi. 2012 Mar;34(3):212-5. doi: 10.3760/cma.j.issn.0253-3766.2012.03.012.
To analyze the efficiency of cervical lymph node metastasis dissection and postoperative morbidity after selective three-field lymph node dissection (3FLND) for thoracic esophageal squamous cell carcinoma, and explore the proper selection conditions.
According to the conditions as follows: systemic evaluation, tumor T staging, tumor location, cervical CT and ultrasonography and the number of lymph nodes metastases, 85 patients with thoracic esophageal squamous cell carcinoma were selected and received 3FLND.
In the same period 45.5% (85/187) of the patients received 3FLND selectively based on the conditions. The rate of the cervical lymph nodes metastasis was 40.0% (34/85). The rate of the cervical positive lymph nodes of the upper, middle and lower thoracic esophageal carcinomas with enlarged lymph nodes suggested by cervical CT and ultrasonography was 68.4% (13/19), 41.7% (20/48) and 16.7% (1/6), respectively. Twelve patients with upper thoracic esophageal carcinoma with enlarged lymph nodes unrevealed by cervical CT and ultrasonography showed no histopathological lymph node metastasis. In the same period 17.1% (32/187) of the patients were selectively not undergone three-field lymph node dissection. The cervical lymph node metastasis rates in patients with upper and middle mediastinal lymph node metastasis were 79.3% (23/29) and 58.6% (17/29), significantly higher than 8.9% (5/56) and 7.1% (4/56) in the patients without upper and middle mediastinal lymph node metastasis (P<0.05). There was no in-hospital mortality in the group. The incidence of pulmonary complications and over-all postoperative morbidity was 24.7% and 42.4%, respectively.
Selective 3FLND based on certain conditions can reduce the risk of postoperative morbidity and improve the efficiency of metastatic cervical lymph node dissection in thoracic esophageal squamous cell carcinoma. The thoracic tracheoesophageal groove positve lymph node indicated by CT scans should be one of selective conditions for 3FLND. The upper thoracic esophageal carcinoma should selectively receive 3FLND. The selection standards should be more strict for the lower thoracic esophageal carcinoma.
分析选择性三野淋巴结清扫术（3FLND）治疗胸段食管鳞状细胞癌时颈部淋巴结转移清扫的效率及术后发病率，探讨合适的选择条件。
根据全身评估、肿瘤T分期、肿瘤位置、颈部CT及超声检查以及淋巴结转移数量等条件，选取85例胸段食管鳞状细胞癌患者行3FLND。
同期45.5%（85/187）的患者根据条件选择性行3FLND。颈部淋巴结转移率为40.0%（34/85）。颈部CT及超声提示有肿大淋巴结的胸段食管上段、中段及下段癌的颈部阳性淋巴结率分别为68.4%（13/19）、41.7%（20/48）及16.7%（1/6）。12例颈部CT及超声未显示有肿大淋巴结的胸段食管上段癌患者无组织病理学淋巴结转移。同期17.1%（32/187）的患者选择性未行三野淋巴结清扫。上纵隔及中纵隔淋巴结转移患者的颈部淋巴结转移率分别为79.3%（23/29）及58.6%（17/29），显著高于无上纵隔及中纵隔淋巴结转移患者的8.9%（5/56）及7.1%（4/56）（P<0.05）。该组无住院死亡病例。肺部并发症发生率及总体术后发病率分别为24.7%和42.4%。
基于特定条件的选择性3FLND可降低胸段食管鳞状细胞癌术后发病风险，提高颈部转移淋巴结清扫效率。CT扫描显示的胸段气管食管沟阳性淋巴结应作为3FLND的选择性条件之一。胸段食管上段癌应选择性行3FLND。胸段食管下段癌的选择标准应更严格。
