Matsuda Satoru, Tsubosa Yasuhiro, Niihara Masahiro, Sato Hiroshi, Takebayashi Katsushi, Kawamorita Keisuke, Mori Keita, Tsushima Takahiro, Yasui Hirofumi, Takeuchi Hiroya, Kitagawa Yuko
Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Ann Surg Oncol. 2015 Feb;22(2):617-23. doi: 10.1245/s10434-014-4017-7. Epub 2014 Aug 28.
The distribution of lymph node (LN) metastases of esophageal squamous cell carcinoma (SCC) with gastric invasion remains unclear. The purpose of this study was to clarify the relationship between gastric invasion and abdominal LN metastasis in patients with esophageal SCC. Furthermore, the clinical validity of gastric tube reconstruction for those with gastric invasion was investigated.
Patients who underwent subtotal esophagectomy at our institution were reviewed. Gastric invasion was evaluated with pretreatment upper gastrointestinal endoscopy and classified into 3 groups: no invasion, Gr 0; slight invasion (0-19 mm), Gr 1; and massive invasion (20 mm or longer), Gr 2. The correlations between gastric invasion, the number of abdominal LN metastases, and postoperative recurrence were investigated.
Of 79 patients, the distribution of pretreatment gastric invasion was Gr 0, 1, and 2 in 57, 15, and 7 patients, respectively. All patients underwent subtotal esophagectomy with gastric tube reconstruction. There was no significant difference in the number of abdominal LN metastases among groups. In survival analysis, the location of the distal end of the tumor was not a predictive factor for postoperative recurrence. Regarding patterns of recurrence, in patients with gastric invasion, there was no remarkable increase in the frequency of recurrence in the abdominal LNs or the regional LNs around the gastric tube.
Pretreatment gastric invasion did not significantly influence abdominal LN metastasis and postoperative recurrence. In patients with esophageal SCC at the lower thoracic esophagus with gastric invasion, subtotal esophagectomy with gastric tube reconstruction might be a valid surgical procedure.
食管鳞状细胞癌（SCC）侵犯胃时淋巴结（LN）转移的分布情况尚不清楚。本研究旨在阐明食管SCC患者胃侵犯与腹部LN转移之间的关系。此外，还研究了胃侵犯患者行胃管重建的临床有效性。
回顾性分析在我院接受食管次全切除术的患者。通过术前上消化道内镜评估胃侵犯情况，并分为3组：无侵犯，Gr 0；轻度侵犯（0 - 19 mm），Gr 1；重度侵犯（20 mm或更长），Gr 2。研究胃侵犯、腹部LN转移数量与术后复发之间的相关性。
79例患者中，术前胃侵犯情况分布为Gr 0、Gr 1和Gr 2的分别有57例、15例和7例。所有患者均接受了食管次全切除术及胃管重建。各组间腹部LN转移数量无显著差异。在生存分析中，肿瘤远端位置不是术后复发的预测因素。关于复发模式，在胃侵犯患者中，腹部LN或胃管周围区域LN的复发频率没有显著增加。
术前胃侵犯对腹部LN转移和术后复发无显著影响。对于侵犯胃的胸段下段食管SCC患者，食管次全切除术加胃管重建可能是一种有效的手术方法。
