Nishimaki T, Suzuki T, Tanaka Y, Nakagawa S, Aizawa K, Hatakeyama K
First Department of Surgery, Niigata University School of Medicine, Japan.
Surg Today. 1997;27(1):3-8. doi: 10.1007/BF01366932.
To define the rational extent of dissection in radical esophagectomy for esophageal cancer, survival was studied according to nodal status in 154 patients undergoing extended radical esophagectomy. The incidence of cervical metastasis in patients with upper or middle esophageal tumors did not differ between those with favorable (grade N < or = 4) or unfavorable (grade N > or = 5) lymph node status, at 28.6% vs 20%, respectively. On the other hand, in patients with lower esophageal tumors, the incidence of cervical metastasis was significantly lower in those with favorable grade (grade N < or = 4) node status than in those with unfavorable grade (grade N > or = 5) node status, at 6.5% vs 46.7%, respectively. Survival did not differ in patients with upper or middle esophageal tumors according to whether they had regional (n = 42) or distant (n = 15) lymph node metastases, the 5-year survival rates being 11.6% vs 25%, respectively. However, in patients with lower esophageal tumors, none of 10 patients with distant node metastases survived for more than 4 years, whereas the survival rate was 43.7% at 5 years for 36 patients with regional node metastases. These results show that cervical lymphadenectomy should only be performed as part of radical esophagectomy in those patients with upper or middle esophageal cancer.
为明确食管癌根治性食管切除术中合理的清扫范围，我们根据154例行扩大根治性食管切除术患者的淋巴结状态对其生存率进行了研究。食管上段或中段肿瘤患者中，颈部转移发生率在淋巴结状态良好（N分级≤4级）和不良（N分级≥5级）的患者之间无差异，分别为28.6%和20%。另一方面，食管下段肿瘤患者中，淋巴结状态良好（N分级≤4级）者的颈部转移发生率显著低于淋巴结状态不良（N分级≥5级）者，分别为6.5%和46.7%。食管上段或中段肿瘤患者中，有区域淋巴结转移（n = 42）和远处淋巴结转移（n = 15）的患者生存率无差异，5年生存率分别为11.6%和25%。然而，食管下段肿瘤患者中，10例有远处淋巴结转移的患者无一存活超过4年，而36例有区域淋巴结转移的患者5年生存率为43.7%。这些结果表明，对于食管上段或中段癌患者，颈部淋巴结清扫仅应作为根治性食管切除术的一部分进行。
