Saito T, Shimoda K, Shigemitsu Y, Kinoshita T, Miyahara M, Kobayashi M
First Department of Surgery, Oita Medical University, Japan.
Surg Today. 1994;24(7):610-5. doi: 10.1007/BF01833725.
Extensive lymphadenectomy (ELA) for esophageal carcinoma has always been limited to low-risk patients; however, we have developed a two-stage operation which extends the indications for ELA to include certain high-risk patients. Of 70 patients who underwent transthoracic subtotal esophagectomy for thoracic esophageal carcinoma between 1986 and 1991, 48 qualified for ELA which was performed on 45, including 27 low-risk patients (group A) whom underwent the traditional one-stage operation, while 18 high-risk patients underwent the two-stage operation (group B). The number of hospital deaths and postoperative complications was similar between the two groups. The median survival was 26 months in group B and 17 months in group A. The 40-day delay in resection of the neck and abdominal nodes in the two-stage operation did not significantly affect lymph node metastases, postoperative recurrence, or long-term survival. Thus, the two-stage operation is an oncologically meaningful approach to the treatment of high-risk patients who present with thoracic esophageal carcinoma.
食管癌广泛淋巴结清扫术（ELA）一直仅限于低风险患者；然而，我们已经开发出一种两阶段手术，将ELA的适应证扩大到包括某些高风险患者。在1986年至1991年间接受经胸胸段食管癌次全切除术的70例患者中，48例符合ELA条件，其中45例接受了ELA，包括27例低风险患者（A组）接受了传统的一期手术，而18例高风险患者接受了两阶段手术（B组）。两组的医院死亡人数和术后并发症相似。B组的中位生存期为26个月，A组为17个月。两阶段手术中颈部和腹部淋巴结切除延迟40天对淋巴结转移、术后复发或长期生存没有显著影响。因此，两阶段手术是治疗胸段食管癌高风险患者的一种具有肿瘤学意义的方法。
