Bhansali M S, Fujita H, Kakegawa T, Yamana H, Ono T, Hikita S, Toh Y, Fujii T, Tou U, Shirouzu K
First Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume City, Fukuoka 830, Japan.
World J Surg. 1997 Mar-Apr;21(3):275-81. doi: 10.1007/s002689900228.
Factors responsible for recurrence of esophageal cancer were investigated in 90 patients who underwent extended radical esophagectomy with three-field dissection for a squamous cell carcinoma in the thoracic esophagus. The initial tumor recurrence was grouped as either locoregional (site of the primary tumor, anastomotic site, or lymph nodes) or as distant (distant organs, pleura, or peritoneum). Nineteen patients (21%) developed a locoregional recurrence, and 19 (21%) developed a distant recurrence. One (1%) developed both recurrences simultaneously and was classified as a distant recurrence. The locoregional recurrence was correlated with the stage factors, particularly the number of metastasis-positive nodes. For the distant recurrence, vascular invasion was found to have been the most important prognostic factor. Our findings suggested that locoregional recurrence was due to tumor progress related to the extent of lymph node metastasis, whereas distant recurrence was due to the oncologic behavior of the tumor. Locoregional recurrence in patients with limited disease may be reduced by extended radical esophagectomy with three-field dissection. Distant recurrence cannot be controlled by surgery. Adopted postoperative adjuvant therapies showed no effect on recurrence.
对90例行扩大根治性食管切除术并三野清扫治疗胸段食管鳞状细胞癌的患者，研究了食管癌复发的相关因素。初始肿瘤复发分为局部区域复发（原发肿瘤部位、吻合口部位或淋巴结）或远处复发（远处器官、胸膜或腹膜）。19例患者（21%）发生局部区域复发，19例（21%）发生远处复发。1例（1%）同时发生两种复发，归类为远处复发。局部区域复发与分期因素相关，尤其是转移阳性淋巴结的数量。对于远处复发，发现血管侵犯是最重要的预后因素。我们的研究结果表明，局部区域复发是由于与淋巴结转移范围相关的肿瘤进展，而远处复发是由于肿瘤的肿瘤学行为。对于疾病局限的患者，扩大根治性食管切除术并三野清扫可能会减少局部区域复发。远处复发无法通过手术控制。采用的术后辅助治疗对复发无影响。
