食管胃交界腺癌与胸段下段食管鳞状细胞癌手术后结局的比较

[Comparison of outcomes after surgery between adenocarcinoma of the esophagogastric junction and lower thoracic esophageal squamous cell cancer].

作者信息

Fu Shi-jie, Fang Wen-tao, Mao Teng, Feng Jian, Gu Zhi-tao, Chen Wen-hu

机构信息

Department of Thoracic Surgery, Shanghai Jiaotong University, Shanghai, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Sep;15(9):893-6.

PMID:22990917

Abstract

OBJECTIVE

To compare the differences in biological behavior and clinical features between adenocarcinoma of the esophagogastric junction (AEG) and lower thoracic esophageal squamous cell cancer (LESC), and to explore reasonable procedures for each cancer.

METHODS

Clinical data of 111 patients with AEG and 126 patients with LESC who underwent surgery from January 2004 to April 2012 were retrospectively reviewed. Data pertaining to resection rate, lymph node metastasis, and postoperative complication rate were analyzed.

RESULTS

The resection rate was 94.6% for AEG and 97.6% for LESC, and the difference was not statistically significant (P<0.05). The rate of lymph node metastasis in the mediastinum in patients with AEG was significantly lower [6.3%(7/111) vs. 32.5%(41/126), P<0.01], while the rate of lymph node metastasis in the abdomen was significantly higher [57.7%(64/111) vs. 34.1%(43/126), P<0.01]. The rate of lymph node metastasis in mediastinum of AEG was 12.5%(4/32) for Siewert I and 4.7%(3/64) for Siewert II, and there was no lymph node metastasis in Siewert III (n=15). For AEG patients who underwent trans-abdominal surgery, the rate of positive lymph node in the middle and lower mediastinum was significantly lower than trans-thoracic surgery [0/22 vs. 7.9% (7/89), P<0.05]. LESC via right thorax with two-field or three-field lymph node dissection was associated with a significantly higher rate of positive lymph node metastasis in the upper mediastinum than that of single incision via left thorax [17.9%(12/67) vs. 0/59, P<0.01]. The postoperative complication rates were 23.4%(26/111) and 27.0%(34/126) respectively, and the difference was not statistically significant(P>0.05).

CONCLUSIONS

AEG and LESC show different lymph node metastasis pattern and should be operated differently. Lymphadenectomy in mid-lower mediastinum should be emphasized in Siewert I and Siewert II type cancers.

摘要

目的

比较食管胃交界腺癌（AEG）与胸段下段食管鳞状细胞癌（LESC）生物学行为及临床特征的差异，探讨两种癌合理的手术方式。

方法

回顾性分析2004年1月至2012年4月期间行手术治疗的111例AEG患者和126例LESC患者的临床资料。分析切除率、淋巴结转移及术后并发症发生率等数据。

结果

AEG的切除率为94.6%，LESC为97.6%，差异无统计学意义（P<0.05）。AEG患者纵隔淋巴结转移率显著低于LESC[6.3%（7/111）对32.5%（41/126），P<0.01]，而腹部淋巴结转移率显著高于LESC[57.7%（64/111）对34.1%（43/126），P<0.01]。Siewert I型AEG患者纵隔淋巴结转移率为12.5%（4/32），Siewert II型为4.7%（3/64），Siewert III型无淋巴结转移（n = 15）。AEG患者经腹手术时，中、下纵隔淋巴结阳性率显著低于经胸手术[0/22对7.9%（7/89），P<0.05]。LESC经右胸行二野或三野淋巴结清扫时，上纵隔淋巴结转移阳性率显著高于经左胸单切口手术[17.9%（12/67）对0/59，P<0.01]。术后并发症发生率分别为23.4%（26/111）和27.0%（34/126），差异无统计学意义（P>0.05）。