Makuuchi H, Machimura T, Sugihara T, So Y, Sasaki T, Tajima T, Mitomi I
Dept. Surg., School of Medicine, Takai Univ. Isehara, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1630-4.
The 117 cases of two regional (thoraco-abdominal) lymph node dissection were compared to the 56 cases of three regional (with neck area in addition) lymph node dissection for esophageal carcinoma. As for operative death and postoperative complications, there were no difference between these two groups. The prognosis of three regional dissecting group was better than that of two regional dissecting group concerning about the cases that lymph node metastases were less than 1 or 2, the depth of invasion was limited to just near adventitia (a1) and the locations were in upper or midthoracic esophagus. But also the rate of postoperative recurrence to the neck and uppermediastinal lymph nodes were high in spite of three regional dissection. Putting together with all cases, significant improvement of prognosis were not obtained in the three regional group compared to two regional group. So we thought the usual three regional lymph node dissection might not be sufficient. Recently we added midsternotomy and made the lymph node dissection in neck-thoracic junction more complete. This procedure did not make the operative death and postoperative complications increase and the improvement of prognosis was expected by it.
将117例行两区域（胸腹部）淋巴结清扫术的食管癌病例与56例行三区域（外加颈部区域）淋巴结清扫术的病例进行比较。在手术死亡和术后并发症方面，两组之间没有差异。对于淋巴结转移少于1或2个、浸润深度仅限于外膜附近（a1）且位置在上段或中段食管的病例，三区域清扫组的预后优于两区域清扫组。但尽管进行了三区域清扫，颈部和上纵隔淋巴结的术后复发率仍很高。综合所有病例来看，与两区域组相比，三区域组的预后并未得到显著改善。因此我们认为常规的三区域淋巴结清扫可能并不充分。最近我们增加了胸骨正中切开术，使颈胸交界处的淋巴结清扫更加彻底。该手术并未导致手术死亡和术后并发症增加，预计可改善预后。
