Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
Department of Breast and Endocrine Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
Ann Surg Oncol. 2019 Apr;26(4):996-1004. doi: 10.1245/s10434-019-07190-5. Epub 2019 Feb 8.
The aim of this study is to elucidate the optimized lymph node dissection range in middle thoracic (Mt) esophageal squamous cell carcinoma (ESCC) requiring surgery.
We retrospectively analyzed 165 ESCC patients who underwent surgery with curative intent between 2009 and 2016, including 99 (60%) with MtESCC. Preoperative chemotherapy was administered in more than 80% of cStage II/III MtESCC patients. The rates of pathological and potential metastasis (representing recurrences) to lymph nodes and prognosis (median follow-up 52 months) were clarified. Lymph node dissection efficacy was assessed by calculating the efficacy index (EI) for each lymph node.
No. 2R had the highest rate of metastasis, with frequencies of 13/38/46% in cStage I/II/III, respectively, with the highest EI in MtESCC. Recurrences were seen in about 2-10% in the regional (nos. 1, 2L, 4R, and 10) and extraregional lymph nodes (paraaortic lymph node). The EI of lymph nodes was found to exhibit the highest score of 15 for no. 2R, followed by 11.5 for no. 17. The 5-year overall survival (OS) in MtESCC patients who underwent no. 2R lymph node dissection was 73.8%, while those who did not undergo no. 2R dissection did never reach 5-year OS (P = 0.002).
Meticulous lymph node dissection of no. 2R is the most important for long-term survival, and mandatory with the highest priority in MtESCC.
本研究旨在阐明需要手术治疗的中胸（Mt）食管鳞癌（ESCC）的最佳淋巴结清扫范围。
我们回顾性分析了 2009 年至 2016 年间接受根治性手术的 165 例 ESCC 患者，其中 99 例（60%）为 MtESCC。超过 80%的 cStage II/III MtESCC 患者接受了术前化疗。明确了淋巴结的病理和潜在转移（代表复发）率以及预后（中位随访 52 个月）。通过计算每个淋巴结的疗效指数（EI）来评估淋巴结清扫的效果。
No.2R 淋巴结转移率最高，cStage I/II/III 分别为 13/38/46%，在 MtESCC 中 EI 最高。区域（No.1、2L、4R 和 10）和区域外淋巴结（主动脉旁淋巴结）的复发率约为 2-10%。淋巴结的 EI 发现最高分为 15 分，No.2R 得分最高，其次是 No.17，得分为 11.5。接受 No.2R 淋巴结清扫的 MtESCC 患者 5 年总生存率（OS）为 73.8%，而未行 No.2R 清扫的患者从未达到 5 年 OS（P=0.002）。
No.2R 的精细淋巴结清扫对长期生存至关重要，在 MtESCC 中应作为最重要和最优先的选择。
