Tsurumaru M, Akiyama H, Udagawa H, Ono Y, Watanabe G, Suzuki M
Toranomon Hospital Department of Surgery, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1612-5.
Five hundred and forty three cases of intrathoracic esophageal carcinoma were reviewed. Of these, one hundred and sixty one cases had collo-thoraco-abdominal (CTA) dissection and three hundred and eighty two cases had thoraco-abdominal (TA) dissection. Postoperative pulmonary complications occurred in 35.5% of the patients who had CTA dissection and in 18.0% of those who had TA dissection. Incidences of postoperative hoarseness of voice and anastomotic leakage were almost similar in the two groups. However, the mortality rates within 30 postoperative days was 4.3% for the CTA groups compared to 1.8% for the TA group. The average number of lymph nodes resected per case was much higher in the CTA group than than the TA group. This implied that the dissection was more extensively performed in the CTA group involving not only bilateral cervical regions but also the upper mediastinum continuing into the neck. Better 1, 2 and 3 years survival rates were observed in the CTA group than the TA group, but for the 4, 5 years survival rates there was no statistical difference noted. For stage-0 and stage-4 carcinoma of the upper third esophagus, marked improvement in the survival rates were obtained in the CTA dissection cases. In conclusion, collo-thoraco-abdominal dissection can be justified for the surgical treatment of intrathoracic esophageal carcinoma despite its postoperative mortality rate of 4.3%.
回顾了543例胸段食管癌病例。其中，161例行颈胸腹（CTA）联合清扫术，382例行胸腹（TA）清扫术。CTA清扫术患者术后肺部并发症发生率为35.5%，TA清扫术患者为18.0%。两组术后声音嘶哑和吻合口漏的发生率几乎相似。然而，CTA组术后30天内死亡率为4.3%，而TA组为1.8%。CTA组每例切除的淋巴结平均数量远高于TA组。这意味着CTA组的清扫范围更广，不仅涉及双侧颈部区域，还包括延伸至颈部的上纵隔。CTA组1年、2年和3年生存率均高于TA组，但4年和5年生存率无统计学差异。对于食管上段0期和4期癌，CTA清扫术病例的生存率有显著提高。总之，尽管颈胸腹联合清扫术术后死亡率为4.3%，但对于胸段食管癌的手术治疗仍是合理的。
