Takeno Shinsuke, Takahashi Yoshiaki, Ono Kiyoshi, Moroga Toshihiko, Yamana Ippei, Maki Kenji, Shiroshita Toyoo, Kawahara Katsunobu, Yamashita Yuichi
Hepatogastroenterology. 2013 Nov-Dec;60(128):1955-60.
BACKGROUND/AIMS: The aim of the present study was to clarify the results and feasibility of surgical approaches for cancer, which is mainly occupied by squamous cell carcinoma (SCC), of the lower esophagus.
Forty-four patients (34 men, 10 women) with cancer located at the lower esophagus were enrolled in this study. SCC was diagnosed in 36 cases and adenocarcinoma (ADC) in 8 cases. Thirteen patients underwent transhiatal esophagectomy, 18 underwent lower thoracic esophagectomy by left thoracotomy, and 13 underwent esophagectomy with a right thoracic approach by open thoracotomy or thoracoscopy.
Ten cases (ADC, n = 2; SCC, n = 8) showed involvement of mediastinal lymph nodes, although lymph node dissection varied with each surgical approach. Five-year survival rates were 75% for ADC and 31.9% for SCC, and ADC tended to be associated with a more favorable prognosis than SCC (p = 0.058). Transhiatal esophagectomy was performed more often in older patients (p < 0.05), but no other clinicopathological parameters appeared to affect the selection of surgical approach. No significant prognostic differences existed between surgical approaches (p = 0.35), even though the examination was limited to SCC (p = 0.98).
No significant prognostic differences were identified between transhiatal and left and right transthoracic approaches for lower esophageal cancer.
背景/目的：本研究旨在阐明主要由鳞状细胞癌（SCC）构成的下食管癌手术方法的结果及可行性。
本研究纳入了44例下食管癌患者（男性34例，女性10例）。其中36例诊断为SCC，8例为腺癌（ADC）。13例患者接受经裂孔食管切除术，18例通过左胸切口行下胸段食管切除术，13例通过开胸手术或胸腔镜采用右胸入路行食管切除术。
10例（ADC 2例，SCC 8例）出现纵隔淋巴结受累，尽管每种手术方法的淋巴结清扫情况各不相同。ADC的5年生存率为75%，SCC为31.9%，且ADC的预后往往比SCC更有利（p = 0.058）。经裂孔食管切除术在老年患者中实施得更为频繁（p < 0.05），但似乎没有其他临床病理参数影响手术方法的选择。手术方法之间不存在显著的预后差异（p = 0.35），即使仅对SCC进行检查也是如此（p = 0.98）。
下食管癌经裂孔与左右经胸手术方法之间未发现显著的预后差异。
