Nishimaki T, Suzuki T, Suzuki S, Kuwabara S, Hatakeyama K
First Department of Surgery, Niigata University School of Medicine, Japan.
J Am Coll Surg. 1998 Mar;186(3):306-12. doi: 10.1016/s1072-7515(98)00013-1.
Great controversy exists concerning the adequate extent of esophagectomy for cure in patients with esophageal cancer. Extended radical esophagectomy combined with three-field lymphadenectomy has been performed to improve the cure rates for patients with the disease in Japan. The purposes of this study were to assess the mortality and morbidity rates after extended radical esophagectomy and to determine the oncologic indications for this procedure.
We reviewed 190 patients who underwent extended radical esophagectomy for invasive esophageal cancer. The procedures were performed prospectively between 1982 and 1996.
The 30-day mortality, in-hospital mortality, and morbidity rates were 1.6%, 4.7%, and 58.4%, respectively. The most common postoperative complication was vocal-cord paralysis (45.3%), followed by major pulmonary complications (21.6%). The overall survival rate for the 190 patients was 41.5% at 5 years, with a median followup period of 61 months. Some subgroups of patients had an extremely poor prognosis despite extended radical esophagectomy. Survival was < or = 5 years in all patients with five or more positive nodes; all patients with simultaneous metastases to the cervical, mediastinal, and abdominal lymph nodes; and all patients with cervical metastases from a lower esophageal tumor.
Extended radical esophagectomy is potentially associated with high morbidity rates although the mortality rates are acceptable, suggesting the necessity of careful patient selection. This procedure is indicated oncologically only for patients with four or fewer metastatic nodes or with metastases confined to one or two of the three anatomic compartments (neck, mediastinum, and abdomen) from upper or midesophageal tumors.
对于食管癌患者为达到治愈目的而行食管切除术的合适范围存在很大争议。在日本，已开展扩大根治性食管切除术联合三野淋巴结清扫术以提高该病患者的治愈率。本研究的目的是评估扩大根治性食管切除术后的死亡率和发病率，并确定该手术的肿瘤学指征。
我们回顾了190例行扩大根治性食管切除术治疗浸润性食管癌的患者。这些手术于1982年至1996年间前瞻性进行。
30天死亡率、住院死亡率和发病率分别为1.6%、4.7%和58.4%。最常见的术后并发症是声带麻痹（45.3%），其次是严重肺部并发症（21.6%）。190例患者的5年总生存率为41.5%，中位随访期为61个月。尽管进行了扩大根治性食管切除术，但部分患者亚组的预后极差。所有有五个或更多阳性淋巴结的患者、所有同时发生颈部、纵隔和腹部淋巴结转移的患者以及所有下段食管癌发生颈部转移的患者，其生存期均≤5年。
扩大根治性食管切除术虽然死亡率可接受，但可能伴有高发病率，提示需要仔细选择患者。该手术在肿瘤学上仅适用于转移淋巴结为四个或更少，或转移局限于上中段食管癌三个解剖区域（颈部、纵隔和腹部）中的一个或两个区域的患者。
