Ide H, Hanyu F, Ishii Y, Kaburagi Y, Yamada A, Murata Y
Dept. of Surgery, Tokyo Women's Medical College, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1626-9.
From 1985 to 1988, we have resected 203 cases of the thoracic esophageal cancer with right thoracotomy. Those 203 cases were classified as R3 (bilateral cervical, thoracic and abdominal node dissection), R2 + alpha (left cervical, thoracic and abdominal nodes dissection) and R2 (thoracic and abdominal node dissection) based on preoperative staging. The background of R3 mainly contained Iu cases, advanced cases, positive cases of upper mediastinal metastasis, and that of R2 mostly contained high aged and risk cases, though this group showed low LN metastasis. The incidence of postoperative complications were higher R3 greater than R2 greater than R2 + alpha in order. Pneumonia had no relationship to neck dissection. Recurrent nerve palsy was recognized in R3 group about 16%. Operative mortality mostly belong to high aged group over 70 y.or., noncurative cases and R3 group. The survival rate of C greater than 0 resected cases with right thoracotomy after 1985 showed some improvement compared with the cases of standard R2 dissection by right thoracotomy from 1980-1984. It showed no difference of the curative survival curve among R3, R2 + alpha and R2 groups. Thus, it is effective to improve the survival rate of resected esophageal cancer with our indication based on preoperative staging.
1985年至1988年期间，我们采用右胸切口对203例胸段食管癌患者进行了手术切除。根据术前分期，这203例患者被分为R3（双侧颈、胸、腹淋巴结清扫）、R2+α（左侧颈、胸、腹淋巴结清扫）和R2（胸、腹淋巴结清扫）三组。R3组的病例主要包括Iu期病例、进展期病例、上纵隔转移阳性病例，而R2组大多为高龄和高危病例，尽管该组淋巴结转移率较低。术后并发症的发生率依次为R3组高于R2组高于R2+α组。肺炎与颈部清扫无关。R3组中约16%的患者出现了喉返神经麻痹。手术死亡率大多集中在70岁以上的高龄组、非根治性病例组和R3组。1985年后采用右胸切口的C大于0切除病例的生存率与1980 - 1984年采用标准右胸切口R2清扫的病例相比有了一定提高。R3、R2+α和R2组之间的根治性生存曲线没有差异。因此，根据术前分期选择合适的手术方式对于提高食管癌切除术后的生存率是有效的。
