CERVICAL, MEDIASTINAL, AND ABDOMINAL LYMPH-NODE DISSECTION (3-FIELD DISSECTION) FOR SUPERFICIAL CARCINOMA OF THE THORACIC ESOPHAGUS
CERVICAL, MEDIASTINAL, AND ABDOMINAL LYMPH-NODE DISSECTION (3-FIELD DISSECTION) FOR SUPERFICIAL CARCINOMA OF THE THORACIC ESOPHAGUS
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DOI：
10.1002/1097-0142(19931115)72:10
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发表时间：
1993-11-15
期刊：
影响因子：
6.2
通讯作者：
OCHIAI, A
中科院分区：
文献类型：
--
作者：
KATO, H;TACHIMORI, Y;OCHIAI, A
背景。近期早期发现的食管癌数量增多，引发了关于其最合适治疗方法的争论。
方法。43例表浅食管癌（SEC）患者接受了食管切除术，并进行了颈部、纵隔和腹部淋巴结清扫（三野清扫）。根据病理数据和手术结果，对治疗的充分性进行了讨论。
结果。3例pTis肿瘤患者无阳性淋巴结。20例患者（46.5%）切除标本中有阳性淋巴结。19个有淋巴结转移的病变（黏膜下癌的57.6%）侵犯至黏膜下。5例黏膜下癌患者（黏膜下癌的15.2%）颈部淋巴结阳性。沿右喉返神经的淋巴结和右心旁淋巴结是最常见的转移部位（16.3%），而右气管旁、隆突下、主动脉弓下、肝总动脉和腹腔淋巴结无转移。手术死亡率为2.3%。3例黏膜下癌患者出现复发疾病。43例患者术后5年生存率为73.2%，淋巴结阳性患者为68.6%。
结论。对于诊断为黏膜下癌的病变患者，建议进行食管切除术及三野淋巴结清扫。内镜黏膜切除术可作为Tis期食管癌患者的首选治疗方法。
Background. The recent increase in the number of esophageal carcinomas detected at an early stage has prompted debate about the most suitable treatment for them.Methods. Forty-three patients with superficial esophageal carcinoma (SEC) underwent esophagectomy with cervical, mediastinal, and abdominal lymph node dissection (three-field dissection). On the basis of the pathologic data and results of surgery, the adequacy of treatment was discussed.Results. Three patients with pTis tumor had no positive lymph nodes. Twenty patients (46.5%) had positive nodes in the resected specimen. Nineteen lesions (57.6% of submucosal cancers) with lymph node metastasis had invasion to the submucosa. Five patients with submucosal cancer (15.2% of submucosal cancers) had positive nodes in the neck. The lymph nodes along the right recurrent nerve and the right paracardiac nodes were the most frequent site of metastasis (16.3%), whereas the right paratracheal, infracarinal, infra-aortic arch, common hepatic, and celiac nodes had no metastasis. The operative mortality rate was 2.3%. Recurrent disease occurred in three patients with submucosal cancer. The 5-year survival rate after surgery was 73.2% for all 43 patients and 68.6% for patients with positive nodes.Conclusions. Esophagectomy with three-field lymph node dissection is recommended for patients with lesions diagnosed as submucosal cancer. Endoscopic mucosectomy is applicable as a first-choice treatment for patients with esophageal carcinoma at Tis.