Altorki N K, Girardi L, Skinner D B
Department of Cardiothoracic Surgery, New York Hospital-Cornell Medical Center, New York 10021, USA.
J Thorac Cardiovasc Surg. 1997 Dec;114(6):948-55; discussion 955-6. doi: 10.1016/S0022-5223(97)70009-6.
The role of en bloc esophagectomy in the surgical treatment of patients with locally advanced esophageal cancer is not well defined. This report attempts to elucidate its impact on survival, in comparison with less extensive resection, among patients with stage III disease.
A prospectively established database was retrospectively analyzed.
One hundred twenty-eight patients underwent esophagectomy for carcinoma of the thoracic esophagus between 1988 and 1996 (78 underwent en bloc resection and 50 underwent standard resection). The 30-day and hospital mortality rates were 3.9% and 5.4%, respectively, comparable for the two procedures. Fifty-four patients had stage III disease. Overall 4-year survival was 34.5% after en bloc resection, with a median survival of 27 months (n = 33), and 11% after standard resection (n = 21), with a median survival of 12 months (p = 0.007). Among patients with stage III disease undergoing a complete resection, 4-year survivals were 36.7% and 0% after en bloc and standard resections, respectively (p = 0.001). Eighty-six of 128 patients had nodal metastasis. Three-year survivals for patients with NI disease were 33.9% and 13% after en bloc and standard resections, respectively (p = 0.02).
Among patients with stage III esophageal cancer, en bloc resection appears to significantly improve survival compared with lesser resections. This improvement in survival may be attributable to resection of nodal disease.
在局部晚期食管癌患者的外科治疗中，整块食管切除术的作用尚未明确界定。本报告旨在阐明与范围较小的切除术相比，其对Ⅲ期疾病患者生存率的影响。
对前瞻性建立的数据库进行回顾性分析。
1988年至1996年间，128例患者因胸段食管癌接受了食管切除术（78例行整块切除术，50例行标准切除术）。两种手术的30天死亡率和住院死亡率分别为3.9%和5.4%，两者相当。54例患者为Ⅲ期疾病。整块切除术后4年总生存率为34.5%，中位生存期为27个月（n = 33）；标准切除术后为11%（n = 21），中位生存期为12个月（p = 0.007）。在接受完整切除的Ⅲ期疾病患者中，整块切除和标准切除术后的4年生存率分别为36.7%和0%（p = 0.001）。128例患者中有86例发生淋巴结转移。N1期疾病患者整块切除和标准切除术后的3年生存率分别为33.9%和13%（p = 0.02）。
在Ⅲ期食管癌患者中，与较小范围的切除术相比，整块切除术似乎能显著提高生存率。生存率的提高可能归因于淋巴结疾病的切除。
