Surgery for thoracic esophageal carcinoma with clinically positive cervical nodes
Surgery for thoracic esophageal carcinoma with clinically positive cervical nodes
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DOI：
10.1016/s0022-5223(98)70046-7
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发表时间：
1998-12-01
影响因子：
6
通讯作者：
Watanabe, H
中科院分区：
文献类型：
--
作者：
Tachimori, Y;Kato, H;Watanabe, H
目的：我们试图通过术前检查来确定是否以及在什么情况下应该推荐胸段食管癌颈淋巴结转移临床阳性的患者进行手术干预。研究方法：根据TNM分期，采用肿瘤解剖部位、T分期、N分期和R分期等因素比较患者的生存率。结果：63例初次手术治疗患者的5年生存率为26.7%。根据肿瘤的位置进行比较时，术后生存率之间没有统计学显著差异。当然，疾病晚期的患者生存率更差。然而，通过多变量分析，肿瘤侵犯邻近结构（T4）的患者与未侵犯邻近结构的患者之间以及接受根治性切除的患者与未接受根治性切除的患者之间存在显著差异。47例手术切除无肿瘤残留者5年生存率为32.9%。结论：即使患者有临床阳性的胸段食管癌颈部淋巴结，他们有可能长期生存后，根治性切除颈部淋巴结清扫。因此，手术是为了治疗的目的。在决定哪些患者需要手术以及如何进行无残留肿瘤的根治性手术时，准确的预处理评估非常重要。
Objective: We attempted to determine whether and under what circumstances surgical intervention should be recommended for patients with clinically positive cervical nodes for metastasis from thoracic esophageal carcinoma by pretreatment examination., Methods: The survival of the patients was compared using factors including anatomic subsites of the tumor, T categories, subdivisions of N categories, and R classification according to the TNM classification. Results: The 5-year survival of 63 patients who underwent surgery for primary therapy was 26.7%. There was no statistically significant difference between the postoperative survivals when compared according to the location of the tumors. As a matter of course, the patients with later stages of the disease had worse survival. However, by the multivariable analysis, significant difference was recognized between the patients with tumor invading adjacent structures (T4) and those without and between the patients who received curative resection and those who did not. The 5-year survival of 47 patients who under,vent surgery without residual tumor was 32.9%. Conclusion: Even when the patient had clinically positive cervical nodes from thoracic esophageal carcinoma, they had a possibility of long-term survival after curative resection with neck lymph node dissection. An operation is thus indicated for curative intent. Accurate pretreatment evaluation is important when deciding which patients require surgery and how to carry out a curative surgical procedure without residual tumor.