Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M
Department of Surgery, Cancer Institute Hospital, Tokyo, Japan.
J Am Coll Surg. 1998 Sep;187(3):238-45. doi: 10.1016/s1072-7515(98)00159-8.
The clinical significance of lymph node involvement along the recurrent laryngeal nerves in cancer of the thoracic esophagus is still controversial. Although these lymph nodes are anatomically located in a well-defined compartment (proximal mesoesophagus), appropriate procedures for dissecting them are not well established.
We retrospectively investigated clinical results over the past 10 years in 276 patients who underwent systematic dissection of cervical, mediastinal, and upper abdominal lymph nodes. We routinely performed the cervical procedure before thoracotomy for total dissection of the proximal mesoesophagus and to minimize the operative risk.
All macroscopically recognizable lesions were resected in 94% of the patients. The hospital mortality rate was 2.5%. Recurrent nerve palsy developed in 59 patients, but it was successfully managed without prolonged hoarseness in 50 of them. The recurrent nerve node group was most frequently involved (frequency of 25% in superficial cancer, 57% in non-superficial cancer). Supradiaphragmatic lymph node involvement was limited to the recurrent nerve nodes in 25% of the patients with positive supradiaphragmatic node. The 5-year survival rate in patients with positive recurrent nerve nodes was 34%.
Dissection of the recurrent nerve lymph nodes is essential for curative esophagectomy even in the early phase of cancer invasion. Our cervicothoracic approach for total dissection of the proximal mesoesophagus yielded acceptable outcomes.
胸段食管癌患者喉返神经周围淋巴结受累的临床意义仍存在争议。尽管这些淋巴结在解剖学上位于一个界限明确的区域（食管中段近端），但针对其清扫的合适手术方式尚未完全确立。
我们回顾性调查了过去10年中276例行颈、纵隔及上腹部淋巴结系统性清扫患者的临床结果。我们常规在开胸手术前行颈部手术，以彻底清扫食管中段近端并降低手术风险。
94%的患者切除了所有肉眼可见的病灶。医院死亡率为2.5%。59例患者出现喉返神经麻痹，但其中50例经成功处理后未出现长期声音嘶哑。喉返神经周围淋巴结组受累最为常见（浅表癌中发生率为25%，非浅表癌中为57%）。在膈上淋巴结阳性的患者中，25%的患者膈上淋巴结受累仅限于喉返神经周围淋巴结。喉返神经周围淋巴结阳性患者的5年生存率为34%。
即使在癌症侵犯的早期阶段，清扫喉返神经周围淋巴结对于根治性食管切除术也至关重要。我们采用的颈胸联合入路彻底清扫食管中段近端取得了可接受的结果。
