Tsutsui S, Kuwano H, Watanabe M, Kitamura M, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Ann Surg. 1995 Aug;222(2):193-202. doi: 10.1097/00000658-199508000-00012.
The safe resection margin in esophagectomy for esophageal squamous cell carcinoma (SCC) was determined based on the extent of epithelial and subepithelial accessory lesions from the main lesions of esophageal SCC.
There have been many reports on the high incidence of a positive resection margin for esophageal cancer. Although there were some studies on the relationships of the proximal clearance to postoperative local recurrence, no pathologic study on the resection margin has been reported.
Four hundred twenty specimens of a whole resected esophagus were examined histopathologically and the longitudinal length from the main lesion to the five types of accessory lesions was measured on microscopic slides.
Contiguous intraepithelial carcinoma existed in 69 (46%) of 150 sites of main lesions restricted to the mucosa or submucosa and subepithelial lesions existed in 131 (54%) of 245 sites and 82 (55%) of 150 sites of main lesions invading an adventitia and into neighboring structures, respectively. The risk of a positive resection margin due to subepithelial lesions was below 5% at 10 mm in the main lesion, restricted to the submucosa or the muscularis propria, and at 30 mm in the main lesion, invading the adventitia in the potentially curative operation cases.
These clearances of the resection margin, in which the risk of a positive resection margin is below 5%, are acceptable, although these clearances should only be accepted after the extent of epithelial accessory lesions is accurately determined by the Lugol's stain method.
基于食管鳞状细胞癌（SCC）主要病变上皮及上皮下附属病变的范围，确定食管癌切除术的安全切缘。
已有许多关于食管癌切缘阳性发生率高的报道。尽管有一些关于近端切缘与术后局部复发关系的研究，但尚未见关于切缘的病理学研究报道。
对420例全切除食管标本进行组织病理学检查，并在显微镜载玻片上测量从主要病变到五种附属病变类型的纵向长度。
局限于黏膜或黏膜下层的主要病变的150个部位中，69个（46%）存在连续性上皮内癌；主要病变侵犯外膜并累及邻近结构的245个部位中的131个（54%）以及150个部位中的82个（55%）存在上皮下病变。在可能治愈性手术病例中，对于局限于黏膜下层或固有肌层的主要病变，切缘因上皮下病变阳性的风险在切缘为10 mm时低于5%；对于侵犯外膜的主要病变，切缘为30 mm时该风险低于5%。
这些切缘切净范围（切缘阳性风险低于5%）是可接受的，尽管只有在通过卢戈氏染色法准确确定上皮附属病变范围后，这些切净范围才可被接受。
