Clark G W, Peters J H, Ireland A P, Ehsan A, Hagen J A, Kiyabu M T, Bremner C G, DeMeester T R
Department of Surgery, University of Southern California, Los Angeles.
Ann Thorac Surg. 1994 Sep;58(3):646-53; discussion 653-4. doi: 10.1016/0003-4975(94)90722-6.
The operative specimens from 43 patients undergoing en bloc esophagectomy for adenocarcinoma of the lower esophagus or cardia were analyzed. Depth of invasion of the tumor and extent and location of lymph node metastases were determined. Postoperative recurrence was identified from positive findings on successive 3-month computed tomographic scans. Positive nodes occurred in 33% (2/6) of intramucosal tumors, 67% (6/9) of intramural tumors, and 89% (25/28) of transmural tumors (p < 0.01). Commonly involved nodes were those in the lesser curve of the stomach (42%), parahiatal nodes (35%), paraesophageal nodes (28%), and celiac nodes (21%). Excluding perioperative deaths, follow-up was complete for 38 patients. Twenty patients had recurrence. Fifteen patients (40%, 15/38) had nodal recurrence: cervical, 7.9% (3/38); superior mediastinal, 21% (8/38); and abdominal, 24% (9/38) (retropancreatic in 7 and retrocrural in 2). Of 5 patients with nodal recurrence alone, 3 (60%) had recurrence at sites outside the margins of resection. Patients with four metastatic nodes or less had a survival advantage over those with more than four (p < 0.05). There was no difference in survival according to location of nodal metastases. Two (22.2%) of 9 patients with celiac node metastases survived longer than 4 years. Adenocarcinoma of the lower esophagus and cardia spreads widely to mediastinal and abdominal nodes, and death can occur from nodal disease. Rates of lymph node metastases increase with the depth of the primary tumor. Patients with lymphatic metastases can be cured particularly if there are fewer than four nodes involved. Curative surgical therapy necessitates wide lymph node resection to ensure removal of all metastatic nodes.
对43例行整块食管切除术治疗下食管或贲门腺癌的患者的手术标本进行了分析。确定肿瘤的浸润深度以及淋巴结转移的范围和部位。通过连续3个月的计算机断层扫描阳性结果确定术后复发情况。黏膜内肿瘤阳性淋巴结发生率为33%（2/6），壁内肿瘤为67%（6/9），透壁肿瘤为89%（25/28）（p<0.01）。常见受累淋巴结为胃小弯处淋巴结（42%）、膈旁淋巴结（35%）、食管旁淋巴结（28%）和腹腔淋巴结（21%）。排除围手术期死亡病例，38例患者获得完整随访。20例患者出现复发。15例患者（40%，15/38）发生淋巴结复发：颈部，7.9%（3/38）；上纵隔，21%（8/38）；腹部，24%（9/38）（胰后7例及膈脚后2例）。仅发生淋巴结复发的5例患者中，3例（60%）在切除边缘以外部位复发。有4个或更少转移淋巴结的患者比有4个以上转移淋巴结的患者生存优势明显（p<0.05）。根据淋巴结转移部位，生存率无差异。9例腹腔淋巴结转移患者中有2例（22.2%）存活超过4年。下食管和贲门腺癌广泛转移至纵隔和腹部淋巴结，可因淋巴结疾病导致死亡。淋巴结转移率随原发肿瘤深度增加而升高。如果受累淋巴结少于4个，有淋巴转移的患者有可能治愈。根治性手术治疗需要广泛切除淋巴结以确保清除所有转移淋巴结。
