Giuli R, Gignoux M
Ann Surg. 1980 Jul;192(1):44-52. doi: 10.1097/00000658-198007000-00008.
A multicenter retrospective statistical study of 2,400 patients with tumors of the esophagus and cardia was undertaken. Study of individual sites revealed the operability of certain carcinomas of the upper third of the esophagus with a reasonable five-year survival rate despite macroscopic invasion seen in more than half the patients. For the middle third of the esophagus, intrathoracic colonic esophagoplasty with esophageal resection extending as high as possible appeared to offer the best long-term results, particularly if the anastomosis was performed in the neck. Tumors of the lower third of the esophagus were also associated with better results when the esophageal anastomosis was made at a level above the aortic arch, resulting in an improved survival rate for patients undergoing intrathoracic colonic esophagoplasties. For carcinomas of the cardia, use of total gastrectomy was superior to the use of upper polar gastrectomy, but the results were better when gastric excision was also associated with esophageal excision. The finding of normal lymph nodes did not preclude recurrence of the tumor in approximately one-fourth of the patients. Esophageal sections at a distance from the tumor was not necessarily synonymous with section in a healthy area, since the sites of sections studied were either invaded (29%) or areas of neoplastic repermeation (40%). Existence of a histologically normal esophageal section site did not preclude recurrences in 27% of patients with more than one-third in the esophagus. Undifferentiated or poorly differentiated squamous cell carcinomas paradoxically appeared to have a somewhat better long-term prognosis than well differentiated forms, but the increased number of metastases associated with them confirms their unfavorable prognosis. The importance of the T/N classification was confirmed for tumors in classes T1 and T2. From Stage T3, the N criterion was not important. Incidence of postoperative mortality from fistulas appeared to decrease progressively, chiefly due to appropriate medical treatment. Cervical fistulas were associated with a mortality rate of 21%. After esophageal anastomosis above the aortic arch was performed, more than 10% of the recurrences were seen in the neck, indicating the need for extension of the incision as high as possible. Metastases to the bone were present in 15% of the patients. Preoperative radiotherapy did not lessen the number of lymph nodes found to be invaded at the time of excision; the tumors considered to be histologically "sterilized" by irradiation were nevertheless associated with a high incidence of lymph node involvement (approximately one-third) and with more than a 40% rate of distant metastases. Excisions considered to be "palliative" by the surgeon nevertheless were of definite value. The mean survival rate at five years was 12%, and one-third of these patients showed no recurrence of neoplasm.
对2400例食管癌和贲门癌患者进行了一项多中心回顾性统计研究。对各个部位的研究表明，尽管超过半数的患者存在肉眼可见的侵犯，但食管上三分之一某些癌肿仍具有可切除性，且五年生存率合理。对于食管中三分之一，尽可能高位进行食管切除的胸内结肠代食管术似乎能提供最佳的长期效果，尤其是当吻合口在颈部进行时。当食管吻合口位于主动脉弓上方时，食管下三分之一的肿瘤也有较好的结果，这使得接受胸内结肠代食管术的患者生存率提高。对于贲门癌，全胃切除术优于上极胃切除术，但当胃切除与食管切除同时进行时，效果更好。发现正常淋巴结并不能排除约四分之一患者肿瘤复发。距肿瘤一定距离处的食管切片不一定等同于健康区域的切片，因为所研究的切片部位要么被侵犯（29%），要么是肿瘤再通区域（40%）。组织学上食管切片部位正常并不能排除27%患者复发，其中超过三分之一的患者食管有病变。矛盾的是，未分化或低分化鳞状细胞癌似乎比高分化型的长期预后稍好，但与之相关的转移数量增加证实了其预后不良。T/N分类对T1和T2期肿瘤的重要性得到了证实。从T3期开始, N标准就不重要了。术后瘘的死亡率似乎逐渐降低，主要是由于适当的医疗治疗。颈部瘘的死亡率为21%。在主动脉弓上方进行食管吻合术后，超过10%的复发发生在颈部，这表明需要尽可能高位延长切口。15%的患者发生骨转移。术前放疗并没有减少切除时发现的被侵犯淋巴结数量；那些被认为经放疗在组织学上“灭活”的肿瘤，其淋巴结受累发生率仍然很高（约三分之一），远处转移率超过40%。外科医生认为是“姑息性”的切除仍然具有明确价值。五年平均生存率为12% , 其中三分之一的患者未出现肿瘤复发。
