Hosoda Kei, Yamashita Keishi, Katada Natsuya, Moriya Hiromitsu, Mieno Hiroaki, Sakuramoto Shinichi, Kikuchi Shiro, Watanabe Masahiko
Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan
Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
Anticancer Res. 2015 Jan;35(1):445-56.
To define the optimal extent of resection for esophagogastric junction (EGJ) carcinoma.
We retrospectively reviewed medical records of 193 patients with EGJ adenocarcinoma or squamous cell carcinoma who underwent surgery at the Kitasato University. An index was calculated to evaluate the therapeutic value of lymphadenectomy.
The following factors were identified as independent predictors of poor survival: (y)pT3-4, (y)pN3, ly2-3, no performance of splenectomy and R1-2. Although metastases were found in mediastinal lymph-nodes in patients with esophageal invasion of ≤30 mm, the index was 0 for all mediastinal lymph-nodes. By contrast, in patients with esophageal invasion of >30 mm, the index was 13.9 for the No. 110 nodes, which was the second highest after the index for the No. 1 nodes.
In EGJ cancer patients with esophageal invasion of >30 mm, aggressive lower mediastinal lymphadenectomy with R0 resection is required to obtain the best result.
确定食管胃交界部（EGJ）癌的最佳切除范围。
我们回顾性分析了在北里大学接受手术的193例EGJ腺癌或鳞状细胞癌患者的病历。计算了一个指数来评估淋巴结清扫的治疗价值。
以下因素被确定为生存不良的独立预测因素：（y）pT3 - 4、（y）pN3、ly2 - 3、未行脾切除术以及R1 - 2。尽管食管侵犯≤30 mm的患者纵隔淋巴结有转移，但所有纵隔淋巴结的指数均为0。相比之下，食管侵犯>30 mm的患者，110组淋巴结的指数为13.9，是仅次于1组淋巴结指数的第二高值。
对于食管侵犯>30 mm的EGJ癌患者，需要进行积极的下纵隔淋巴结清扫并达到R0切除以获得最佳疗效。
