Mitomi T, Makuucuhi H
Department of Surgery, Tokai University, School of Medicine, Isehara, Japan.
Nihon Geka Gakkai Zasshi. 1997 Sep;98(9):727-32.
Proper mucosal cancer of esophagus of esophageal has no lymph node metastasis, and lymph node metastasis occurs when the tumor invades to muscularis mucosa. Submucosal cancer of esophagus has lymph node metastasis in the rate of 44.4% (40/90). The incidence and number of metastatic lymph node increase with the depth of invasion. Lymph node metastasis of esophageal cancer spreads widely to cervix, mediastinum and abdomen. It's same in submucosal cancer and first metastasis occurs also appears at everywhere from cervix to abdomen. There are high rate of lymph node metastasis in 101L, 105, 106rR, 106rL, 108, 110, 1, 2, 3, 7 lymph nodes. The cancer in upper thoracic esophagus has high rate of lymph node metastasis in cervix and upper mediastinum and lymph node metastasis of lower thoracic esophageal cancer is liable to appear in lower mediastinum and abdomen. Then the cancer in middle thoracic esophagus should be performed the lymph node dissection in cervix, mediastinum and abdomen, especially 101, 102m, 104, 105, 106r, 106t, 107, 108, 110, 1, 2, 3, 7 lymph nodes. On the other hand, cancers limited to proper mucosal layer should be treated with endoscopic mucosal resection. And its same as in the greater part of cancers invaded to muscularis mucosa and shallow layer of esophageal submucosa. The 5 year survival rate of T1 cancers of esophagus is 85.6%, which were performed surgical treatment.
食管原位黏膜癌无淋巴结转移,肿瘤侵犯至黏膜肌层时发生淋巴结转移。食管黏膜下癌淋巴结转移率为44.4%(40/90)。转移淋巴结的发生率及数量随浸润深度增加而增多。食管癌的淋巴结转移广泛扩散至颈部、纵隔和腹部。黏膜下癌情况相同,首次转移也可出现在从颈部到腹部的任何部位。101L、105、106rR、106rL、108、110、1、2、3、7区淋巴结有较高的淋巴结转移率。胸段上段食管癌在颈部和上纵隔有较高的淋巴结转移率,胸段下段食管癌的淋巴结转移易出现在下纵隔和腹部。因此,胸段中段食管癌应行颈部、纵隔和腹部淋巴结清扫,尤其是101、102m、104、105、106r、106t、107、108、110、1、2、3、7区淋巴结。另一方面,局限于原位黏膜层的癌应采用内镜黏膜切除术治疗。大多数侵犯至黏膜肌层和食管黏膜下层浅层的癌也是如此。接受手术治疗的食管T1期癌的5年生存率为85.6%。