Nigro J J, Hagen J A, DeMeester T R, DeMeester S R, Peters J H, Oberg S, Theisen J, Kiyabu M, Crookes P F, Bremner C G
University of Southern California, Department of Surgery, Los Angeles, Calif.90033-4612, USA.
J Thorac Cardiovasc Surg. 1999 Jan;117(1):16-23; discussion 23-5. doi: 10.1016/s0022-5223(99)70464-2.
The purpose of this study was to characterize the prevalence and location of regional lymph node metastases in adenocarcinoma confined to the esophagal wall, to determine the extent of dissection required, and to investigate the applicability of nonoperative therapy.
Histologic evaluation of the resected specimens after en bloc esophagogastrectomy with mediastinal and abdominal lymphadenectomy was performed on 37 patients with adenocarcinoma confined to the esophageal wall. Follow-up was complete in all patients (median 24 months).
Fifteen patients (41%) had intramucosal tumors. Twelve (32%) had submucosal tumors and 10 (27%) had muscular invasion. The prevalence of regional lymph node metastases (15/37 patients, 41%) increased progressively with depth of tumor invasion, with involved nodes identified in 80% of patients with muscular invasion. Lymph node metastases were also more common at distant node stations in intramuscular tumors (5/10, 50%). Actuarial survival for the entire group was 63% at 5 years. Recurrence was identified in 6 of the 37 patients (16%), with the risk of recurrence correlating with tumor depth.
Tumor depth is a strong predictor of the probabilities of regional lymph node metastases, the likelihood of involvement of distant node groups, and the risk of recurrence. Patients with invasion of the muscular wall are at particularly high risk. En bloc esophagectomy with mediastinal and abdominal lymphadenectomy has the highest likelihood of achieving an R0 resection. The long-term survival and low recurrence rate achieved with an en bloc esophagectomy emphasizes the importance of an aggressive lymph node dissection to remove all potentially involved nodes.
本研究旨在描述局限于食管壁的腺癌区域淋巴结转移的发生率和位置，确定所需的清扫范围，并探讨非手术治疗的适用性。
对37例局限于食管壁的腺癌患者进行了整块食管胃切除术并纵隔和腹部淋巴结清扫术后切除标本的组织学评估。所有患者均完成随访（中位随访时间24个月）。
15例患者（41%）为黏膜内肿瘤。12例（32%）为黏膜下肿瘤，10例（27%）有肌层浸润。区域淋巴结转移的发生率（15/37例患者，41%）随肿瘤浸润深度逐渐增加，肌层浸润患者中80%发现有受累淋巴结。肌层内肿瘤远处淋巴结站的淋巴结转移也更常见（5/10，50%）。整个组的5年总生存率为63%。37例患者中有6例（16%）出现复发，复发风险与肿瘤深度相关。
肿瘤深度是区域淋巴结转移概率、远处淋巴结组受累可能性及复发风险的有力预测指标。肌层浸润患者风险尤其高。整块食管切除术加纵隔和腹部淋巴结清扫术实现R0切除的可能性最高。整块食管切除术实现的长期生存和低复发率强调了积极淋巴结清扫以清除所有潜在受累淋巴结的重要性。
