Peracchia A, Bonavina L, Incarbone R, Chella B
Istituto di Chirurgia Generale e Oncologia Chirurgica Università di Milano, Ospedale Maggiore Policlinico, I.R.C.C.S. Pad. Monteggia, Italia.
J Chir (Paris). 1997 Nov;134(5-6):209-13.
Between 1980 and 1997, 1194 patients with a malignant tumor of the lower esophagus have been observed and treated in our Institution. There were 555 patients (46.5%) presenting with squamous-cell carcinoma, 101 (8.5%), with Barrett's adenocarcinoma and 538 (45%) with cardia adenocarcinoma. Most patient underwent a transthoracic esophagectomy with esophagogastroplasty; transhiatal approach was mainly reserved to high-risk patients. Over the past two years sixty-three patients (42 with adenocarcinoma and 21 with squamous cell carcinoma) underwent enlarged mediastinal lymphadenectomy. Three patients (4.7%) died post-operatively: one sepsis, in pulmonary embolism and one myocardial infarction. Four patients (6.3%) developed pulmonary complications: no patient had recuriential palsy. Pathologic exam revealed 1342 nodes (807 thoracic and 827 abdominal). Twenty patients (31.7%) had mediastinal nodal metastases, of which 8 in the upper mediastinum. Median follow-up was 19 months (2-36 months). Seven of the sixteen patients with recurrent disease (12 systemic, 3 mediastinal and 1 anastomotic) died. The number of metastatic nodes increased with serial section and even more with immunohistochemical staining technique (from 11.7% to 13% to 15.5%, respectively). Two patients were up-staged from M0 to M1 because of peripancreatic nodal micrometastases. We conclude that enlarged mediastinal lymphadenectomy allowed to detect upper mediastinal lymph node metastases in 12.8% of patients without increasing post-operative complication rate. A longer follow-up is required to evaluate the impact on long term survival.
1980年至1997年间，我院共观察并治疗了1194例食管下段恶性肿瘤患者。其中555例（46.5%）为鳞状细胞癌，101例（8.5%）为巴雷特腺癌，538例（45%）为贲门腺癌。大多数患者接受了经胸食管切除术并进行食管胃成形术；经裂孔手术主要用于高危患者。在过去两年中，63例患者（42例腺癌和21例鳞状细胞癌）接受了扩大纵隔淋巴结清扫术。3例患者（4.7%）术后死亡：1例死于败血症，1例死于肺栓塞，1例死于心肌梗死。4例患者（6.3%）出现肺部并发症：无患者发生复发性麻痹。病理检查发现1342个淋巴结（807个胸部淋巴结和827个腹部淋巴结）。20例患者（31.7%）有纵隔淋巴结转移，其中8例位于上纵隔。中位随访时间为19个月（2至36个月）。16例复发患者中有7例死亡（12例为全身复发，3例为纵隔复发，1例为吻合口复发）。随着连续切片以及免疫组化染色技术的应用，转移淋巴结的数量增加（分别从11.7%增至13%再增至15.5%）。2例患者因胰周淋巴结微转移从M0期上调至M1期。我们得出结论，扩大纵隔淋巴结清扫术可使12.8%的患者检测到上纵隔淋巴结转移，且不增加术后并发症发生率。需要更长时间的随访来评估其对长期生存的影响。
