Autopsy findings in patients after curative esophagectomy for esophageal carcinoma
Autopsy findings in patients after curative esophagectomy for esophageal carcinoma
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DOI：
10.1016/s1072-7515(03)00116-9
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发表时间：
2003-06-01
影响因子：
5.2
通讯作者：
Kaminishi, M
中科院分区：
文献类型：
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作者：
Katayama, A;Mahme, K;Kaminishi, M
背景技术背景：食管癌食管切除术后复发的模式很少被详细研究，从尸检findings.Study设计：我们回顾了尸检结果在43治愈切除的情况下，食管癌在1976年和1997年在一个单一的institution.Results：复发或残留的食管癌被确定在27的43例（62.8%）在尸检。局部复发11例（25.6%），淋巴结转移18例（41.9%），血行转移17例（39.5%），浆膜转移11例（25.6%）。尸检时分别有37.2%、16.3%和11.6%的病例观察到胸、腹和颈淋巴结转移。肺门淋巴结最常见（25.6%）。根治性食管次全切除术联合两个或三个野解剖（19.4%）后的局部复发率显著低于食管下段切除术（66.7%）（p = 0.032）。治疗性食管切除术后，术前放疗后的血行转移的频率显着降低应答者（等级2至3）比无应答者（等级0至1）（p = 0.035）。结论：这项研究显示了食管癌食管切除术后复发的特点。尽管进行了食管切除术和淋巴结清扫术，但每种复发模式的频率都非常高。提出了通过外科手术完全切除淋巴结的解剖困难。血行转移和浆膜转移癌是手术切除不了的。需要更有效的多模式治疗来提高食管癌患者的生存率。(C)2003年由美国外科医生学会。
BACKGROUND: The mode of recurrence after esophagectomy for esophageal cancer has seldom been studied in detail from autopsy findings.STUDY DESIGN: We reviewed the autopsy findings in 43 curatively resected cases of esophageal cancer between 1976 and 1997 at a single institution.RESULTS: Recurrent or residual esophageal cancer was identified in 27 of the 43 patients (62.8%) at autopsy. Local recurrence, lymph node metastases, hematogenous metastases, and serosal carcinomatosis were observed in 11 (25.6%), 18 (41.9%), 17 (39.5%), and I I patients (25.6%), respectively. Metastases to the thoracic, abdominal, and cervical nodes were observed in 37.2%, 16.3%, and 11.6% of the cases at autopsy, respectively. The pulmonary hilar nodes were most frequently involved (25.6%). The frequency of local recurrence was significantly lower in cases after curative subtotal esophagectomy with two- or three-field dissection (19.4%) than in cases after lower esophagectomy (66.7%) (p = 0.032). The frequency of hematogenous metastases after curative esophagectomy after preoperative radiotherapy was significantly lower in responders (Grades 2 to 3) than in nonresponders (Grades 0 to 1) (p = 0.035).CONCLUSIONS: This study showed the characteristics of recurrence after esophagectomy for esophageal cancer. Despite esophagectomy with lymph node dissection, the frequency of each mode of recurrence was remarkably high. Anatomic difficulty of complete removal of lymph nodes by surgical procedures was suggested. Hematogenous metastases and serosal carcinomatosis were beyond surgical resection. More effective multimodal therapy will be required to improve survival of esophageal cancer patients. (C) 2003 by the American College of Surgeons.