Three-field versus Two-field lymphoadenectomy for Upper or Middle Thoracic Esophageal Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

蔡彥力 ,  鄭勇 , 黃進啟 , 向水 , 姚元波

恩施土家族苗族自治州中心醫院心胸外科(湖北恩施 445000);

Corresponding?author：

鄭勇, Email: caiyl_2004@sina.com

Keywords：

食管癌; 外科治療; 三野淋巴結清掃術; 完全二野淋巴結清掃術

DOI：

10.7507/1007-4848.20160118

Video：

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目的探討胸中上段食管癌淋巴結清掃的合理范圍。方法回顧性分析2010年1月至2013年10月我院134例胸中上段食管癌淋巴結清掃患者的臨床資料。將患者分為兩組：三野組，56例，男50例、女6例，年齡（55.4±9.6）歲，行三野淋巴結清掃根治術；二野組，78例，男69例、女9例，年齡（56.3±7.3）歲，行完全二野淋巴結清掃根治術。比較兩組臨床效果。結果三野組患者淋巴結轉移率明顯高于二野組（60.7%vs.42.3%，P < 0.05），主要差別在于三野組有較高的頸部淋巴結轉移率（21.4%）。三野組與二野組患者上縱隔淋巴結轉移率分別為33.9%和30.8%，差異無統計學意義（P>0.05）。三野組及二野組患者術后并發癥發生率差異無統計學意義（P>0.05）。三野組及二野組患者術后１年生存率分別為96.3%和85.5%，差異有統計學意義（P < 0.05）；三野組及二野組患者術后1年內頸部淋巴結復發率分別為1.9%和11.8%，差異有統計學意義（P < 0.05）。結論三野淋巴結清掃根治術有助于提高胸中上段食管癌手術根治性，能減少術后局部復發和轉移，提高患者術后生存率，相對于完全二野淋巴結清掃術并不顯著增加手術并發癥。

Citation： 蔡彥力, 鄭勇, 黃進啟, 向水, 姚元波. Three-field versus Two-field lymphoadenectomy for Upper or Middle Thoracic Esophageal Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 506-508. doi: 10.7507/1007-4848.20160118 Copy

1.	Sugiyama M, Morita M, Yoshida R, et al. Patterns and time of recurrence after complete resection of esophageal cancer. Surg Today, 2012, 42(1):752-758.
2.	毛友生, 赫捷, 程貴余, 等. 食管癌分期與治療的共識、爭議和建議. 中國癌癥雜志, 2011, 21(7):511-517.
3.	蔡英杰, 何澤鋒, 柯孫葵, 等. 胸段食管癌鎖骨上淋巴結清掃的臨床價值. 中國胸心血管外科臨床雜志, 2013, 20(1):63-66.
4.	Liu Q, Cai XW, Wu B, et al. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma:implications for the clinical target volume design of postoperative radiotherapy. Plos One, 2014, 9(5):e97225.
5.	Ding X, Zhang J, Li B, et al. A meta-analysis of lymph node metas-tasis in thoracic esophageal cancer. Br J Radiol, 2012, 85(1019):e1110-e1119.
6.	繆瓏異, 相加慶. 食管癌三野淋巴結清掃根治術的價值. 中國癌癥雜志, 2004, 14(2):194-196.
7.	Matsubara T, Ueda M, Abe T, et al. Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic esophagus. Br J Surg, 1999, 86:669-673.
8.	Berger AC, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coil Surg, 2011, 212:560-568.
9.	Udagawa H, Ueno M, Shinohara H, et al. The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol, 2012, 106(6):742-747.
10.	Ye T, Sun Y, Zhang Y, et al. Three-field or two-field resection for thoracic esophageal cancer:a meta-analysis. Ann Thorac Surg, 2013, 96(6):1933-1941.
11.	Kato H, Fukuchi M, Miyazaki T, et al. Classification of recurrent esophageal cancer after radical esophagectomy with two or three field lymphadenectomy. J Anticancer, 2005, 25(5):3461-3467.

1. Sugiyama M, Morita M, Yoshida R, et al. Patterns and time of recurrence after complete resection of esophageal cancer. Surg Today, 2012, 42(1):752-758.
2. 毛友生, 赫捷, 程貴余, 等. 食管癌分期與治療的共識、爭議和建議. 中國癌癥雜志, 2011, 21(7):511-517.
3. 蔡英杰, 何澤鋒, 柯孫葵, 等. 胸段食管癌鎖骨上淋巴結清掃的臨床價值. 中國胸心血管外科臨床雜志, 2013, 20(1):63-66.
4. Liu Q, Cai XW, Wu B, et al. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma:implications for the clinical target volume design of postoperative radiotherapy. Plos One, 2014, 9(5):e97225.
5. Ding X, Zhang J, Li B, et al. A meta-analysis of lymph node metas-tasis in thoracic esophageal cancer. Br J Radiol, 2012, 85(1019):e1110-e1119.
6. 繆瓏異, 相加慶. 食管癌三野淋巴結清掃根治術的價值. 中國癌癥雜志, 2004, 14(2):194-196.
7. Matsubara T, Ueda M, Abe T, et al. Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic esophagus. Br J Surg, 1999, 86:669-673.
8. Berger AC, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coil Surg, 2011, 212:560-568.
9. Udagawa H, Ueno M, Shinohara H, et al. The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol, 2012, 106(6):742-747.
10. Ye T, Sun Y, Zhang Y, et al. Three-field or two-field resection for thoracic esophageal cancer:a meta-analysis. Ann Thorac Surg, 2013, 96(6):1933-1941.
11. Kato H, Fukuchi M, Miyazaki T, et al. Classification of recurrent esophageal cancer after radical esophagectomy with two or three field lymphadenectomy. J Anticancer, 2005, 25(5):3461-3467.

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Three-field versus Two-field lymphoadenectomy for Upper or Middle Thoracic Esophageal Cancer

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