Hagens Eliza R C, van Berge Henegouwen Mark I, Cuesta Miguel A, Gisbertz Suzanne S
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
J Thorac Dis. 2017 Jul;9(Suppl 8):S713-S723. doi: 10.21037/jtd.2017.07.42.
The incidence of esophageal cancer increases, with approximately 482,000 patients diagnosed with esophageal cancer each year. Despite the growing incidence of esophageal carcinoma, the extent of the lymphadenectomy is still under discussion. Lymph node status is an important prognostic parameter in esophageal cancer and an independent predictor of survival. Surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy differs worldwide. For squamous cell cancer, Japanese surgeons have standardized the 2- or 3-field lymphadenectomy according to the location of the tumor. For adenocarcinoma, in the Western World accounting for 85% of all esophageal cancers, the type of lymphadenectomy to perform is not clear. Moreover, the use of neoadjuvant therapy may influence the mediastinal lymph nodes and the significance of the lymphadenectomy for survival. These aspects have challenged the traditional policy concerning lymphadenectomy, at least in the Western World. Furthermore, an extensive lymphadenectomy may improve survival but, on the other hand, may cause significant more morbidity. An overview of the literature on the extent of lymphadenectomy for esophageal cancer with respect to the supposed lymph node distribution patterns for squamous cell carcinoma and adenocarcinoma, the different lymph node classification systems, the commonly used surgical techniques and outcomes, and the proposal of observational cohort study to standardize the type of lymphadenectomy according to the type of tumor, location and use of neoadjuvant therapy will be provided.
食管癌的发病率呈上升趋势，每年约有48.2万名患者被诊断为食管癌。尽管食管癌的发病率不断上升，但淋巴结清扫的范围仍在讨论之中。淋巴结状态是食管癌的一个重要预后参数，也是生存的独立预测指标。手术策略取决于淋巴结转移的分布模式，但全球对于淋巴结清扫范围的共识存在差异。对于鳞状细胞癌，日本外科医生已根据肿瘤位置将二野或三野淋巴结清扫标准化。对于占所有食管癌85%的腺癌，在西方世界，应进行何种类型的淋巴结清扫尚不清楚。此外，新辅助治疗的使用可能会影响纵隔淋巴结，以及淋巴结清扫对生存的意义。至少在西方世界，这些方面对传统的淋巴结清扫政策提出了挑战。此外，广泛的淋巴结清扫可能会提高生存率，但另一方面，可能会导致更多的并发症。本文将概述关于食管癌淋巴结清扫范围的文献，内容涉及鳞状细胞癌和腺癌假定的淋巴结分布模式、不同的淋巴结分类系统、常用的手术技术和结果，以及根据肿瘤类型、位置和新辅助治疗的使用情况对淋巴结清扫类型进行标准化的观察性队列研究建议。
