Muroi M
Department of Surgery, Tokyo Metropolitan Komagome General Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Mar;43(3):287-99.
In order to evaluate clinical effect of the extensive lymph node dissection for thoracic esophageal cancer, 78 cases with esophagectomy and extensive lymph node dissection were reviewed. Pathological depth of invasion was the submucosa (sm: 25 cases), the proper muscle (pm: 7 cases), al (8 cases) and a2 (38 cases). Incidence of operative death rate in 30 days was 2.8% of all cases and hospital death rate 5.1%. Lymph node metastasis was identified in 65% of all cases (cervical metastasis occupied 19.2% of all cases with metastasis, mediastinal metastasis 48.7% and abdominal metastasis 34.6%). Over all cumulative three year survival rate was 55.3% (sm 88.9%, pm & al 55.6% and a2 40%). Postoperative recurrence was analyzed on thirty eight cases with more than three years passed after esophagectomy with extensive lymph node dissection. Postoperative recurrence was detected in 50% of all cases (local recurrence occupied 16% of all cases with recurrence, distant organ metastasis 58%, lymph node metastasis 21% and dissemination 5%). Extensive lymph node dissection significantly elongated disease free interval and survival time of cases with recurrence and lymph node metastasis, but there was no significant improvement in cases with other mode of recurrence. Dissecting field was classified into four regions (cervical, paratracheal, periesophageal and abdominal regions). Number of lymph nodes with metastasis and number of regions with lymph node metastasis showed close relationship with incidence of post operative recurrence. In cases with number of lymph node metastasis more than six and in more than two regions, all cases resulted in recurrence. Extensive lymph node dissection have an effect improving survival rate on cases with number of lymph node metastasis less than five and in less than two regions.
为评估胸段食管癌广泛淋巴结清扫术的临床效果，回顾性分析78例行食管癌切除及广泛淋巴结清扫术的病例。病理浸润深度为黏膜下层（sm：25例）、固有肌层（pm：7例）、al（8例）和a2（38例）。30天手术死亡率为所有病例的2.8%，住院死亡率为5.1%。65%的病例发现有淋巴结转移（颈部转移占所有转移病例的19.2%，纵隔转移占48.7%，腹部转移占34.6%）。总体三年累积生存率为55.3%（sm为88.9%，pm和al为55.6%，a2为40%）。对38例食管癌切除及广泛淋巴结清扫术后超过三年的病例进行术后复发分析。所有病例中50%检测到术后复发（局部复发占所有复发病例的16%，远处器官转移占58%，淋巴结转移占21%，播散占5%）。广泛淋巴结清扫显著延长了复发和淋巴结转移病例的无病间期和生存时间，但对其他复发模式的病例无显著改善。清扫区域分为四个区域（颈部、气管旁、食管周围和腹部区域）。有转移的淋巴结数量和有淋巴结转移的区域数量与术后复发率密切相关。有转移的淋巴结数量超过6个且在两个以上区域的病例，均出现复发。广泛淋巴结清扫对有转移的淋巴结数量少于5个且在两个以下区域的病例有提高生存率的作用。
