Natsugoe S, Aikou T, Yoshinaka H, Miyazono F, Shimada M, Hokita S, Baba M, Takao S
First Department of Surgery, Faculty of Medicine, Kagoshima University, Japan.
Nihon Geka Gakkai Zasshi. 1998 Sep;99(9):575-80.
We retrospectively analyzed the clinicopathological findings in 141 patients with advanced cardiac cancer. According to histological type, 117 patients had an adenocarcinoma and 24 patients a squamous cell carcinoma. Curative resection was performed in 114 patients, whereas the remaining 27 patients underwent palliative resection. Preoperative endoscopic ultrasonography and abdominal ultrasound were useful for the diagnosis of esophageal invasion and lymph node metastases. Particularly, the classification of paraaortic lymph node metastasis by ultrasound was important in deciding on the surgical method. Mediastinal lymph node metastases were found histologically in 19 of 68 patients. The survival of patients with mediastinal lymph node metastasis was poor. However, among them, a favorable outcome was expected for patients with few involved nodes and if only perigastric node involvement in abdominal nodes was found. Paraaortic lymph node metastasis was found histologically in 15 of 48 patients (27.9%). Two of 35-year survivors had 5 or fewer lymph node metastases, and showed only perigastric and paraaortic node involvement. It is equally important that tumor extension and lymph node metastases in the mediastinum and abdomen should be determined in the surgical treatment of advanced carcinoma of the cardia.
我们回顾性分析了141例晚期贲门癌患者的临床病理特征。根据组织学类型，117例为腺癌，24例为鳞状细胞癌。114例患者接受了根治性切除，其余27例患者接受了姑息性切除。术前内镜超声检查和腹部超声检查对诊断食管侵犯和淋巴结转移很有用。特别是，超声对主动脉旁淋巴结转移的分类对于决定手术方式很重要。68例患者中有19例经组织学检查发现纵隔淋巴结转移。纵隔淋巴结转移患者的生存率较低。然而，其中，淋巴结受累较少且仅发现腹部淋巴结有胃周淋巴结受累的患者预期预后良好。48例患者中有15例（27.9%）经组织学检查发现主动脉旁淋巴结转移。35例生存患者中有2例的淋巴结转移数为5个或更少，且仅表现为胃周和主动脉旁淋巴结受累。在贲门癌的外科治疗中，确定纵隔和腹部的肿瘤侵犯范围和淋巴结转移情况同样重要。
