Junginger T, Dutkowski P, Böttger T, Wahl W
Klinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz.
Chirurg. 1995 Jul;66(7):693-703.
Between September 1985 and December 1993 280 patients suffering from esophageal cancer underwent treatment at the department of general and abdominal surgery at the University of Mainz. Of the 167 patients operated, 152 patients had an esophageal resection performed in 113 cases as abdominothoracic resection and in 39 cases via the transmediastinal approach. 104 patients were curative resected (R0). Recurrence-free and total survival were correlated to the extent of the mediastinal lymph node dissection supposing comparable operative stress. The mean recurrence-free and the mean total survival after abdominothoracic resection with 2-field lymph node dissection were 42.4 months resp. 47.3 vs. 18.9 months resp. 25.2 months after transmediastinal resection (p = 0.015 and p = 0.035). We suggest a differentiated surgical approach concerning abdominothoracic resection with 2-field lymph node dissection for limited tumor size (pT1-3 pN0-1 M0), if the operative risk is tolerable. The transmediastinal resection appears to be only enough radical in cases with early tumor stages (UICC 0-I) and also is advantageous for risk patients with simultaneously more advanced tumor (palliative resection), because of the lower operative stress.
1985年9月至1993年12月期间，280例食管癌患者在美因茨大学普通外科和腹部外科接受治疗。在167例接受手术的患者中，152例患者进行了食管切除术，其中113例为胸腹联合切除术，39例通过经纵隔途径进行。104例患者接受了根治性切除（R0）。假设手术应激相当，无复发生存率和总生存率与纵隔淋巴结清扫范围相关。胸腹联合切除并进行二野淋巴结清扫后的平均无复发生存期和平均总生存期分别为42.4个月和47.3个月，而经纵隔切除后的平均无复发生存期和平均总生存期分别为18.9个月和25.2个月（p = 0.015和p = 0.035）。对于肿瘤大小有限（pT1 - 3 pN0 - 1 M0）且手术风险可耐受的患者，我们建议采用胸腹联合切除并进行二野淋巴结清扫的差异化手术方法。经纵隔切除似乎仅在肿瘤早期阶段（UICC 0 - I）足够根治，并且对于同时患有更晚期肿瘤的高危患者（姑息性切除）也有利，因为手术应激较低。
