胸段食管癌进展期癌行三野清扫术加食管切除的适应证。

Indications for three-field dissection followed by esophagectomy for advanced carcinoma of the thoracic esophagus.

作者信息

Tabira Y, Okuma T, Kondo K, Kitamura N

机构信息

First Department of Surgery, Kumamoto University, School of Medicine, Kumamoto, and Izumi City Hospital, Izumi City, Kagoshima, Japan.

出版信息

J Thorac Cardiovasc Surg. 1999 Feb;117(2):239-45. doi: 10.1016/S0022-5223(99)70418-6.

DOI:10.1016/S0022-5223(99)70418-6

PMID:9918963

Abstract

OBJECTIVE

The aim of this study was to evaluate the indication for 3-field lymphadenectomy (3-field dissection) followed by esophagectomy for locally advanced carcinoma of the thoracic esophagus in the presence of lymph node metastasis.

METHODS

From January 1983 to December 1995, 86 patients with thoracic esophageal carcinoma invading muscularis propria or adventitia underwent radical subtotal esophagectomy after preoperative chemotherapy. Forty-six of the 86 patients underwent a 2-field dissection (mediastinal and abdominal nodes, group A), and 40 patients underwent a 3-field dissection (bilateral cervical, mediastinal, and abdominal nodes, group B). Survival curves were compared between the 2 groups after stratification according to the degree of lymph node involvement (number of positive nodes and involvement of intrathoracic or intrathoracic recurrent nerve chain nodes). Potential prognostic factors of these 86 patients were evaluated by means of Cox regression analysis.

RESULTS

There were no significant differences in age, sex ratio, depth of tumor invasion, pTNM classification, or number of positive nodes between the 2 groups. Among patients with positive intrathoracic nodes, the 5-year survival of group B (42%) was significantly longer than that of group A (13%, generalized Wilcoxon test P =.02). Among patients with 1 to 4 positive nodes, the 5-year survival of group B (54%) was significantly higher than that of group A (22%, P =.01). Multivariate analysis revealed the number of positive nodes, age, and pT4 stage to be significant predictors of survival in patients with thoracic esophageal carcinoma.

CONCLUSIONS

Three-field dissection for advanced carcinoma of the thoracic esophagus is effective in patients with 1 to 4 positive nodes.

摘要

目的

本研究旨在评估在存在淋巴结转移的情况下，对于局部晚期胸段食管癌行三野淋巴结清扫术（三野清扫）后再行食管切除术的适应证。

方法

1983年1月至1995年12月，86例侵犯固有肌层或外膜的胸段食管癌患者在术前化疗后接受了根治性次全食管切除术。86例患者中，46例行二野清扫（纵隔和腹部淋巴结，A组），40例行三野清扫（双侧颈部、纵隔和腹部淋巴结，B组）。根据淋巴结受累程度（阳性淋巴结数量以及胸段或胸段复发神经链淋巴结受累情况）进行分层后，比较两组的生存曲线。通过Cox回归分析评估这86例患者的潜在预后因素。

结果

两组在年龄、性别比、肿瘤浸润深度、pTNM分类或阳性淋巴结数量方面均无显著差异。在胸段淋巴结阳性的患者中，B组的5年生存率（42%）显著高于A组（13%，广义Wilcoxon检验P = 0.02）。在有1至4个阳性淋巴结的患者中，B组的5年生存率（54%）显著高于A组（22%，P = 0.01）。多变量分析显示，阳性淋巴结数量、年龄和pT4期是胸段食管癌患者生存的重要预测因素。