Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Gastrointest Surg. 2017 Oct;21(10):1584-1590. doi: 10.1007/s11605-017-3471-5. Epub 2017 Jun 23.
The aim of this study is to investigate the utility of total mediastinal lymphadenectomy (ML) in superficial esophageal squamous cell carcinoma (ESCC).
The medical records of 129 patients who underwent esophagectomy and lymph node dissection for pathologically confirmed pT1 ESCC between July 2006 and December 2014 were retrospectively reviewed. Limited ML, such as traditional 2-field or transhiatal esophagectomy, was performed in 42 patients (group 1), and total ML, including the bilateral recurrent laryngeal nerve nodes, was performed in 87 patients (group 2).
R0 resection was achieved in all patients, and the number of dissected nodes was 28.0 ± 11.4 and 44.8 ± 16.1 in groups 1 and 2 (p < 0.001), respectively. The complication profile was similar in the two groups, but there were two operative mortalities in group 2. During a median follow-up of 32.4 months, loco-regional failure was found in 14.3% of group 1 and 3.5% of group 2 (p = 0.001). There was a significant difference in the 3-year overall survival (95.1% in group 2 vs. 83.3% in group 1, p = 0.043), and the 3-year disease-free survival rates (92.3% in group 2 vs. 73.7% in group 1, p = 0.001). On multivariate analysis, the extent of ML (HR, 5.200; 95% CI, 1.532 ~ 17.645; p = 0.008) and pT1b lesion classification (HR, 4.747; 95% CI, 1.024 ~ 21.997; p = 0.047) was a factor predictive of disease-free survival.
Total ML might be beneficial, especially in cases of pT1b ESCC, because it could lead to a lower incidence of recurrence and longer survival times.
本研究旨在探讨全纵隔淋巴结清扫术（ML）在浅表性食管鳞癌（ESCC）中的应用价值。
回顾性分析 2006 年 7 月至 2014 年 12 月期间 129 例经病理证实为 pT1 ESCC 行食管切除术和淋巴结清扫术的患者的病历资料。42 例患者行局限性 ML，如传统 2 野或经胸食管切除术（组 1），87 例患者行全纵隔 ML，包括双侧喉返神经淋巴结（组 2）。
所有患者均行 R0 切除，组 1 和组 2 分别清扫 28.0±11.4 和 44.8±16.1 枚淋巴结（p<0.001）。两组并发症谱相似，但组 2 有 2 例手术死亡。中位随访 32.4 个月时，组 1 和组 2 的局部区域复发率分别为 14.3%和 3.5%（p=0.001）。组 2 的 3 年总生存率（95.1%）明显高于组 1（83.3%）（p=0.043），3 年无病生存率（92.3% vs. 73.7%）也明显高于组 1（p=0.001）。多因素分析显示，ML 范围（HR，5.200；95%CI，1.53217.645；p=0.008）和 pT1b 病变分类（HR，4.747；95%CI，1.02421.997；p=0.047）是无病生存率的预测因素。
全纵隔 ML 可能有益，尤其是对于 pT1b ESCC，因为它可以降低复发率和提高生存率。
