Koide Y, Okazumi S, Shimada H, Matsubara H, Miyazawa Y, Arima M, Komori A, Fukunaga T, Isono K
Second Department of Surgery, Chiba University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1997 Sep;98(9):742-6.
In order to determine the reasonable lymph node dissection for T2 or T3 midthoracic esophageal cancer with cervical lymph node metastasis, a retrospective study was carried out on 106 patients receiving resection between 1983 and 1996. Metastasis to cervical lymph node was obtained in 27.4% (29/106) of patients with T2 or T3 midthoracic esophageal cancer. Within 29 patients, metastasis in cervical node only, in two fields and in three fields occupied 17.2%, 41.4% and 41.4%, respectively. And according to the histologic examination of dissected lymph nodes, metastatic sites spreaded from neck to perigastric region. Five-year survival rate of 23 patients receiving curative operation was 33.0%, and that of 13 patients excluding 3-field metastasis was 51.9%. But the main sites of nodal recurrence were cervical or superior mediastinal nodes along the bilateral recurrent laryngeal nerves, and the rate of nodal recurrence was 47.8%. These results of actual state of lymph node metastasis and prognostic benefit of aggressive dissection suggest that 3-field lymph node dissection is mandatory for T2 or T3 midthoracic esophageal cancer with cervical lymph node metastasis. And we should endeavor to upgrade the precise dissection in order to decrease the nodal recurrence.
为确定伴有颈部淋巴结转移的T2或T3期胸段食管癌合理的淋巴结清扫范围，对1983年至1996年间接受手术切除的106例患者进行了一项回顾性研究。在T2或T3期胸段食管癌患者中，27.4%（29/106）出现颈部淋巴结转移。在这29例患者中，仅颈部淋巴结转移、二野淋巴结转移和三野淋巴结转移分别占17.2%、41.4%和41.4%。根据清扫淋巴结的组织学检查，转移部位从颈部蔓延至胃周区域。23例行根治性手术患者的5年生存率为33.0%，13例排除三野转移患者的5年生存率为51.9%。但淋巴结复发的主要部位是双侧喉返神经旁的颈部或上纵隔淋巴结，淋巴结复发率为47.8%。这些淋巴结转移实际情况及积极清扫的预后获益结果表明，对于伴有颈部淋巴结转移的T2或T3期胸段食管癌，三野淋巴结清扫是必要的。并且我们应努力提升清扫的精确性以降低淋巴结复发。
