Metastasis Feature and Dissecting Value of Cervicothoracic Lymph Node for Middle Esophageal Squamous Carcinoma: A Prospective Cohort Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 MAOZhi-ming ¹ , GUXiao-hua ¹ , LIChang-yan ² , ZHUDong-bing ³ , HUANGHai-sheng ⁴ , MAOWang-shan ¹ , ZHANGTao ¹ , SUNJian ¹ , ZHAOYang ⁵

1. Department of Thoracic Surgery, Rugao Boai Hospital, Rugao 226500 Jiangsu, P. R. China;
2. Department of Thoracic Surgery, Rugao People's Hospital, Rugao 226500 Jiangsu, P. R. China;
3. Department of Pathology, Rugao People's Hospital, Rugao 226500 Jiangsu, P. R. China;
4. Department of Pathology, Rugao Boai Hospital, Rugao 226500 Jiangsu, P. R. China;
5. Department of Epidemiology and Health Statistics, The Public Health College of Nanjing, Medical University, Nanjing 211166, P. R. China;

Corresponding?author：

MAOZhi-ming, Email: Rgsmzm@126.com

Keywords：

Esophageal carcinoma; Esophagogastrostomy; Lymph node dissection; Cervicothoracic junction; Prospective cohort study

DOI：

10.7507/1007-4848.20150256

Video：

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Objective To evaluate the metastasis feature and the dissecting value of cervicothoracic lymph node for middle esophageal squamous carcinoma. Methods A total of 303 patients admitted to the Rugao Boai Hospital(107 patients) and the Rugao People's Hospital (196 patients) received the stapled cervical esophagogastrostomy via different thoracic approach according to the admission order number between March 2005 and February 2013. There were 290 patients with Ro resections including 149 patients by Ivor-Lewis approach (an Ivor-Lewis group) and 141 patients by Sweet approach (a Sweet group). The data of lymph nodal dissection and PTNM stage and follow-up of the two groups were analyzed. Results The number of positive lymph nodes dissected from the cervicothoracic junction in the IvorLewis group was significantly greater than that in own upper abdomen (Z=3.12, P<0.05) and that in the cervicothoracic junctionin in the Sweet group (Z=3.30, P<0.05). The lymph node metastasis rate of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen(χ²=10.76, P<0.05)and that in the cervicothoracic junction in the Sweet group (χ²=7.34, P<0.05). The lymph node ratio (LNR) of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen (χ²=11.67, P<0.05) and that in the cervicothoracic junction in the Sweet group (χ²=5.99, P<0.05). The proportion of patients which PTNM were Ⅲa or Ⅲb as N＞N₁ in the Ivor-Lewis group was significantly higher than that in the Sweet group(χ²=5.59, P<0.05). After surgery of 1 year, 3 years, 5 years, the rate of lymph node local recurrence and the total rate of tumor metastasis or recurrence in the Ivor-Lewis group were significantly lower than in the Sweet group (P<0.05). The survival rate in the Ivor-Lewis group was significantly greater than that in the Sweet group (P<0.05). Conclusion The cervicothoracic junction has a higher incidence of lymphatic metastasis, which transfer intensity is greater than that of upper abdomen. The extended cervicothoracic lymph node dissection should be indeed indispensible to increase of radical resection and the accuracy of PTNM stage and to improve the long term survival for middle esophageal carcinoma.

Citation： MAOZhi-ming, GUXiao-hua, LIChang-yan, ZHUDong-bing, HUANGHai-sheng, MAOWang-shan, ZHANGTao, SUNJian, ZHAOYang. Metastasis Feature and Dissecting Value of Cervicothoracic Lymph Node for Middle Esophageal Squamous Carcinoma: A Prospective Cohort Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1031-1035. doi: 10.7507/1007-4848.20150256 Copy

1.	Akiyama H,Tsurumaru M,Udagawa H,et al.Radical lymph node dissection for cancer of esophagus.Ann Surg,994,220(3):364-373.
2.	方文濤,茅騰,谷志濤.微創食管癌根治術-優勢與風險.中華胸心血管外科雜志,2013,29(7):392-393.
3.	毛友生,赫捷,薛奇,等.全國食管癌規范化診治推廣之路.中華胃腸外科雜志,2013,16(9):801-804.
4.	牛中喜,陳龍奇.NCCN2013食管癌臨床實踐指南解讀.中國胸心血管外科臨床雜志,2014,21(1):5-6.
5.	丁建勇,徐松濤.食管癌三野淋巴結清掃術的回顧和展望.中國臨床醫學,2011,18(6):879-882.
6.	Tachimori Y,Nagai Y,Kanamori N,et al.Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system.Dis Esophagus,2011,24(1):33-38.
7.	Tachibana M,Kinugasa S,Yoshimura H,et al.Extended esophagectomy with 3-field lymph node dissection for esophageal cancer.Arch Surg,2003:138(12):1383-1389.
8.	中國醫師協會食管外科專家委員會.微創食管癌切除術(minimally invasive esophagectomy,MIE)專家共識.中華胸心血管外科雜志,2013,29(7):385-387.
9.	于頻,主編.系統解剖學.第4版.北京:人民衛生出版.1996.295-296.
10.	柳碩巖,鄭慶豐,王楓.胸腔鏡腹腔鏡下食管癌三野淋巴結清掃術必要性與可行性.中華胸心血管外科雜志,2013,29(7):394-397.
11.	方文濤,陳文虎.食管癌手術治療原則和淋巴結清掃.中國癌癥雜志,2011,(21)7:522-527.
12.	Schwarz RE,Smith DD.Clinical Impact of lymphadenectoy extent in resectable esophageal cancer.J Gastrointest Surg,2007,11:1384-1394.
13.	Fujita H,Sueyoshi S,Tanaka T,et al.Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus:comparing the short and long term outcome among the four types of lymphadenectomy.World J Surg,2003,27(5):571-579.
14.	冒志明,劉勁柏,趙凱國,等.經胸頸段食管胃機械吻合術的臨床應用(附82例報告).中華胸心血管外科雜志,1996,12(2):89-90.
15.	冒志明,顧曉華,李昌炎,等.Ivor-Lewis經胸頸部機械吻合術治療中段食管癌的前瞻性研究.中華消化外科雜志,2013,12(10):367-371.
16.	于長海,孫玉鶚.經胸食管胃頸部機械吻合在食管癌手術中的應用.中華胸心血管外科雜志,2000,16(2):114-115.
17.	張曉,郎保平,靳超,等.經胸食管胃頸部機械吻合在食管癌治療中的應用.河南科技大學學報(醫學版),2004,22(2):87-88.
18.	錢衛平,徐林友,吳斌.經右胸食管胃頸部機械吻合32例分析.皖南醫學院學報,2010,29(1):62-63.
19.	汪永和,魏祥志,岳慶峰,等.中段食管癌根治術擴大二野清掃淋巴結的臨床體會.安徽醫學,2013,34(1):31-33.
20.	Kuge K,Murakami G,Mizobuchi S,et al.Submucosal territory of direct lymphatic drainage system to the thoracic duct in the human esophagus.Thorac Cardiovasc Surg,2003,125:1343-1349.
21.	Mizutani M,Murakakami G,Nawata S,et al.Anatomy of right recurrent nerve node:why does early metastasis of esophageal cancer occur in it?Surg Radiol Anat,2006,28(4):333-338.
22.	Liebermann-Meffert D.Anatomical basis for the approach and extent of surgical treatment of esophageal cancer.Dis Esophagus,2001,14(2):81-84.

1. Akiyama H,Tsurumaru M,Udagawa H,et al.Radical lymph node dissection for cancer of esophagus.Ann Surg,994,220(3):364-373.
2. 方文濤,茅騰,谷志濤.微創食管癌根治術-優勢與風險.中華胸心血管外科雜志,2013,29(7):392-393.
3. 毛友生,赫捷,薛奇,等.全國食管癌規范化診治推廣之路.中華胃腸外科雜志,2013,16(9):801-804.
4. 牛中喜,陳龍奇.NCCN2013食管癌臨床實踐指南解讀.中國胸心血管外科臨床雜志,2014,21(1):5-6.
5. 丁建勇,徐松濤.食管癌三野淋巴結清掃術的回顧和展望.中國臨床醫學,2011,18(6):879-882.
6. Tachimori Y,Nagai Y,Kanamori N,et al.Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system.Dis Esophagus,2011,24(1):33-38.
7. Tachibana M,Kinugasa S,Yoshimura H,et al.Extended esophagectomy with 3-field lymph node dissection for esophageal cancer.Arch Surg,2003:138(12):1383-1389.
8. 中國醫師協會食管外科專家委員會.微創食管癌切除術(minimally invasive esophagectomy,MIE)專家共識.中華胸心血管外科雜志,2013,29(7):385-387.
9. 于頻,主編.系統解剖學.第4版.北京:人民衛生出版.1996.295-296.
10. 柳碩巖,鄭慶豐,王楓.胸腔鏡腹腔鏡下食管癌三野淋巴結清掃術必要性與可行性.中華胸心血管外科雜志,2013,29(7):394-397.
11. 方文濤,陳文虎.食管癌手術治療原則和淋巴結清掃.中國癌癥雜志,2011,(21)7:522-527.
12. Schwarz RE,Smith DD.Clinical Impact of lymphadenectoy extent in resectable esophageal cancer.J Gastrointest Surg,2007,11:1384-1394.
13. Fujita H,Sueyoshi S,Tanaka T,et al.Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus:comparing the short and long term outcome among the four types of lymphadenectomy.World J Surg,2003,27(5):571-579.
14. 冒志明,劉勁柏,趙凱國,等.經胸頸段食管胃機械吻合術的臨床應用(附82例報告).中華胸心血管外科雜志,1996,12(2):89-90.
15. 冒志明,顧曉華,李昌炎,等.Ivor-Lewis經胸頸部機械吻合術治療中段食管癌的前瞻性研究.中華消化外科雜志,2013,12(10):367-371.
16. 于長海,孫玉鶚.經胸食管胃頸部機械吻合在食管癌手術中的應用.中華胸心血管外科雜志,2000,16(2):114-115.
17. 張曉,郎保平,靳超,等.經胸食管胃頸部機械吻合在食管癌治療中的應用.河南科技大學學報(醫學版),2004,22(2):87-88.
18. 錢衛平,徐林友,吳斌.經右胸食管胃頸部機械吻合32例分析.皖南醫學院學報,2010,29(1):62-63.
19. 汪永和,魏祥志,岳慶峰,等.中段食管癌根治術擴大二野清掃淋巴結的臨床體會.安徽醫學,2013,34(1):31-33.
20. Kuge K,Murakami G,Mizobuchi S,et al.Submucosal territory of direct lymphatic drainage system to the thoracic duct in the human esophagus.Thorac Cardiovasc Surg,2003,125:1343-1349.
21. Mizutani M,Murakakami G,Nawata S,et al.Anatomy of right recurrent nerve node:why does early metastasis of esophageal cancer occur in it?Surg Radiol Anat,2006,28(4):333-338.
22. Liebermann-Meffert D.Anatomical basis for the approach and extent of surgical treatment of esophageal cancer.Dis Esophagus,2001,14(2):81-84.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Metastasis Feature and Dissecting Value of Cervicothoracic Lymph Node for Middle Esophageal Squamous Carcinoma: A Prospective Cohort Study

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