Morita M, Kuwano H, Ohno S, Furusawa M, Sugimachi K
Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan.
Surgery. 1994 Jul;116(1):1-7.
A large number of patients with esophageal cancer experience recurrence, even when a curative operation is performed. The purpose of this study was to clarify the characteristics of recurrence after a curative esophagectomy.
The patterns and the time of recurrence after curative esophagectomy were examined in 187 cases of thoracic esophageal cancer. Ninety-five of these patients died of evident recurrence. The recurrence patterns were classified into lymphatic, hematogenic, mixed type (lymphatic and concomitant hematogenic), and intramural recurrences.
The number of cases in each recurrence group were 46, 23, 22, and 4, respectively. The disease free intervals were fairly closely correlated with pTNM stage in the lymphatic and mixed type groups whereas they were within 2 years in all cases of the hematogenic group. Among the 22 cases of the mixed type, hematogenic recurrence preceded lymphatic recurrence in only one case. Furthermore, 17 of 20 cases with either cervical or mediastinal lymph node recurrence of the mixed type were accompanied with lung recurrence, whereas the remaining two cases with abdominal lymph node recurrence had liver recurrence.
These findings suggest that most mixed type recurrences and most lymphatic ones are primarily caused by lymph node metastases; thus the importance of a radical lymphadenectomy was supported. On the other hand, a careful examination for hematogenic recurrence is essential soon after operation.
大量食管癌患者即使接受了根治性手术仍会复发。本研究的目的是阐明根治性食管切除术后复发的特征。
对187例胸段食管癌患者根治性食管切除术后的复发模式和时间进行了研究。其中95例患者死于明显复发。复发模式分为淋巴道转移、血行转移、混合型（淋巴道转移并伴有血行转移）和壁内复发。
各复发组的病例数分别为46、23、22和4例。无病生存期在淋巴道转移组和混合型组中与pTNM分期密切相关，而在血行转移组的所有病例中均在2年内。在22例混合型病例中，仅1例血行转移复发先于淋巴道转移复发。此外，混合型中20例有颈部或纵隔淋巴结复发的病例中有17例伴有肺复发，而其余2例有腹部淋巴结复发的病例有肝复发。
这些发现表明，大多数混合型复发和大多数淋巴道转移复发主要由淋巴结转移引起；因此支持了根治性淋巴结清扫术的重要性。另一方面，术后早期仔细检查血行转移复发至关重要。
