Junginger T, Dutkowski P
Department of General and Abdominal Surgery, University of Mainz, Germany.
Br J Surg. 1996 Oct;83(10):1473-7. doi: 10.1002/bjs.1800831047.
Between September 1985 and December 1994, 322 patients with oesophageal cancer were treated. Of the 190 patients who underwent operation, 173 had an oesophageal resection; in 124 this was performed as an abdominothoracic resection and in 49 by the transhiatal approach. The assessment of radicality after histological examination revealed a curative (R0) resection in 121 patients (70 per cent) and a palliative (R1-R2) resection in 52 (30 per cent). Prognosis was correlated with the extent of mediastinal lymph node dissection. In 77 patients with stage pT1-3 pN0-1 pM0 the 5-year survival rate was 40 per cent after abdominothoracic resection with two-field lymph node dissection and zero after transhiatal resection (P = 0.01). The authors propose a differentiated surgical approach involving abdominothoracic resection with two-field lymph node dissection for patients with limited tumours (pT1-3 pN0-1 M0) if the operative risk is tolerable. Transhiatal resection appears to be effective only in patients with early tumours (Union Internacional Contra la Cancrum stage 0).
1985年9月至1994年12月期间，共治疗了322例食管癌患者。在190例接受手术的患者中，173例行食管切除术；其中124例采用胸腹联合切除术，49例采用经裂孔途径。组织学检查后对根治性的评估显示，121例患者（70%）为根治性（R0）切除，52例患者（30%）为姑息性（R1-R2）切除。预后与纵隔淋巴结清扫范围相关。在77例pT1-3 pN0-1 pM0期患者中，胸腹联合切除并进行两野淋巴结清扫后的5年生存率为40%，经裂孔切除后的5年生存率为零（P = 0.01）。作者建议，对于肿瘤局限（pT1-3 pN0-1 M0）且手术风险可耐受的患者，采用包括胸腹联合切除并进行两野淋巴结清扫的差异化手术方法。经裂孔切除似乎仅对早期肿瘤患者（国际抗癌联盟0期）有效。
