Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections:: Impact on staging, disease-free survival, and outcome -: A plea for adaptation of TNM classification in upper-half esophageal carcinoma
Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections:: Impact on staging, disease-free survival, and outcome -: A plea for adaptation of TNM classification in upper-half esophageal carcinoma
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DOI：
10.1097/01.sla.0000145925.70409.d7
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发表时间：
2004-12-01
影响因子：
9
通讯作者：
Ectors, N
中科院分区：
文献类型：
--
作者：
Lerut, T;Nafteux, P;Ectors, N
目的：确定食管切除术联合三野淋巴结清扫术对食管癌和胃食管连接部癌（GEJ）患者分期、无病生存率和5年生存率的影响。背景：食管切除术联合三野淋巴结清扫术主要在日本进行。来自西方的三野淋巴结切除术的数据很少，而且涉及的病例相对较少。因此，它在食管癌和GEJ的外科实践中的作用仍然存在争议。研究方法：在1991年至1999年期间，在192例患者中进行了一期手术与3野淋巴结清扫术，其中一组174例R 0切除术用于进一步analysis.Results：整个系列的住院死亡率为1.2%。总发病率为58%。肺部并发症发生率为32.8%，心律失常发生率为10.9%，持续性返神经问题发生率为2.6%。pTNM分期如下：0期，0.6 /0; I期，9.2%; II期，27.6 /0; III期，28.7%; IV期，33.9%。总的3年和5年生存率分别为51%和41.9%。3年和5年无瘤生存率分别为51.4%和46.3%。局部区域淋巴结复发率为5.2%;无患者发生孤立性颈部淋巴结复发。淋巴结阴性患者的5年生存率为80.2%，淋巴结阳性患者为24.5%。分期的5年生存率为：0期和I期100%，II期59.1%，III期36.8%，IV期13.3%。23%的腺癌患者（25.8%远端1/3和17.6% GEJ）和25%的鳞状细胞癌患者（26.2%中间1/3）有阳性颈部淋巴结，导致pTNM分期改变，特别是与12%的不可预见的颈部淋巴结受累有关。75.6%的患者在病理检查时未发现颈部淋巴结转移。中三分之一鳞状细胞癌患者的5年生存率为27.7%。对于远端第三腺癌，4年生存率为35.7%，5年生存率为11.9%。结论：食管癌切除术后3野淋巴结清扫术死亡率低，并发症可接受。无论肿瘤的类型和位置如何，受累颈部淋巴结的患病率都很高，导致12%的患者的最终分期发生变化，特别是与颈部淋巴结相关。R切除术后的5年和无病生存率分别为41.9%和46.3%，可能表明了真实的生存获益。中三分之一癌的颈部淋巴结阳性患者的5年生存率为27.2%，表明这些淋巴结应被视为中三分之一癌的区域转移（N1），而不是远处转移（M1 b）。这些患者似乎受益于3场淋巴结切除术。3区域淋巴结切除术在远端第三腺癌中的作用仍在研究中。
Objective: To determine the impact of esophagectomy with 3-field lymphadenectomy on staging, disease-free survival, and 5-year survival in patients with carcinoma of the esophagus and gastroesophageal junction (GEJ).Background: Esophagectomy with 3-field lymphadenectomy is mainly performed in Japan. Data from Western experience with 3-field lymphadenectomy are scarce and dealing with relatively small numbers. As a result, its role in the surgical practice of cancer of the esophagus and GEJ remains controversial. Methods: Between 1991 and 1999, primary surgery with 3-field lymphadenectomy was performed in 192 patients, of whom a cohort of 174 R0 resections was used for further analysis.Results: Hospital mortality of the whole series was 1.2%. Overall morbidity was 58%. Pulmonary complications occurred in 32.8%, cardiac dysrhythmias in 10.9%, and persistent recurrent nerve problems in 2.6%. pTNM staging was as follows: stage 0, 0.6 /0; stage I, 9.2%; stage II, 27.6 /0; stage III, 28.7%; and stage IV, 33.9%. Overall 3- and 5-year survival was 51% and 41.9%, respectively. The 3- and 5-year disease-free survival was 51.4% and 46.3%, respectively. Locoregional lymph node recurrence was 5.2%; no patient developed an isolated cervical lymph node recurrence. Five-year survival for node-negative patients was 80.2% versus 24.5% for node-positive patients. Five-year survival by stage was 100% in stages 0 and I, 59.1% in stage II, 36.8% in stage III, and 13.3% in stage IV. Twenty-three percent of the patients with adenocarcinoma (25.8% distal third and 17.6% GEJ) and 25% of the patients with squamous cell carcinoma (26.2% middle third) had positive cervical nodes resulting in a change of pTNM staging specifically related to the unforeseen cervical lymph node involvement in 12%. Cervical lymph node involvement was unforeseen in 75.6% of patients with cervical nodes at pathologic examinations. Five-year survival for patients with positive cervical nodes was 27.7% for middle third squamous cell carcinoma. For distal third adenocarcinomas, 4-year survival was 35.7% and 5-year survival 11.9%. No GEJ adenocarcinoma with positive cervical nodes survived for 5 years.Conclusions: Esophagectomy with 3-field lymph node dissection can be performed with low mortality and acceptable morbidity. The prevalence of involved cervical nodes is high, regardless of the type and location of tumor resulting in a change of final staging specifically related to the cervical field in 12% of this series. Overall 5-year and disease-free survival after R resection of 41.9% and 46.3%, respectively, may indicate a real survival benefit. A 5-year survival of 27.2% in patients with positive cervical nodes in middle third carcinomas indicates that these nodes should be considered as regional (N1) rather than distant metastasis (M1b) in middle third carcinomas. These patients seem to benefit from a 3-field lymphadenectomy. The role of 3-field lymphadenectomy in distal third adenocarcinoma remains investigational.