Fujita H, Kakegawa T, Yamana H, Shirouzu G, Minami T, Ono T, Tsugane S
First Department of Surgery, Kurume University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1623-5.
Over the period from 1982 to 1988, 127 cases with carcinoma in the thoracic esophagus underwent curative resection through a right thoracotomy. Cervicothoracic-abdominal lymph node dissection was performed in twenty-seven cases. No operative death occurred and only one hospital death (4%) was recorded. The only postoperative complication was recurrent laryngeal nerve palsy. Based on the adjusted survival-rate curves using Cox's method, there was significant difference in prognosis in favor of these 27 cases that received cervicothoracic-abdominal lymph node dissection over those that did not. The survival rate of all curatively operated cases was noticeably improved by using this procedure. Of those that underwent dissection only, or dissection with postoperative radiotherapy or chemotherapy, the best prognosis could be reached by a combination of the cervicothoracic-abdominal lymph node dissection and postoperative chemotherapy. From follow-up data regarding recurrence rates, a more extended dissection and complete removal of lymph nodes in the left upper mediastinum and retroperitoneum should further improve the long-term prognosis.
在1982年至1988年期间，127例胸段食管癌患者通过右胸切口进行了根治性切除。其中27例行颈胸腹淋巴结清扫术。无手术死亡病例，仅记录到1例医院死亡（4%）。术后唯一的并发症是喉返神经麻痹。根据使用Cox方法调整后的生存率曲线，接受颈胸腹淋巴结清扫术的这27例患者的预后明显优于未接受清扫术的患者。采用该手术方法，所有接受根治性手术病例的生存率显著提高。在仅行清扫术、清扫术联合术后放疗或化疗的患者中，颈胸腹淋巴结清扫术联合术后化疗可达到最佳预后。从关于复发率的随访数据来看，更广泛的清扫以及彻底清除左上纵隔和腹膜后的淋巴结应能进一步改善长期预后。
