食管胃交界部腺癌与胸下段食管鳞癌外科治疗结果的比较分析

Comparison of outcomes after surgery between adenocarcinoma of the esophagogastric junction and lower thoracic esophageal squamous cell cancer

目的比较食管胃交界部腺癌（AEG）与胸下段食管鳞癌（LESC）生物学行为和临床特点．探索各自合理的手术方式。方法回顾性分析2004年1月至2012年4月间上海交通大学附属胸科医院收治的111例AEG和126例LESC患者的临床资料．比较两组病例手术切除率、淋巴结转移情况及术后并发症发生率的差异。结果AEG组和LESC组患者的手术切除率分别为94．6％（105／111）和97．6％（123／126），差异无统计学意义（P〉0．05）。AEG组患者纵隔淋巴结转移率明显低于LESC组f6．3％（7／111）比32．5％（41／126），P〈0．011，腹腔淋巴结转移率则明显高于LESC组[57．7％（64／111）比34．1％（43／126），P〈0．01]。SiewertⅠ型和SiewertⅡ型AEG纵隔淋巴结转移率分别为12．5％（4／32）和4．7％（3／64）．而15例siewertⅢ型AEG患者则未发现纵隔淋巴结转移。AEG单纯经腹手术者，中下纵隔淋巴结转移检出率显著低于经胸手术者[0／22比7．9％（7／89），P〈0．05]：LESC经右胸行二野或三野淋巴结清扫者，上纵隔淋巴结转移检出率明显高于经左胸单一切口者[17．9％（12／67）比0／59，P〈0．01]。两组患者术后并发症发生率分别为23．4％（26／111）和27．0％（34／126）。差异无统计学意义（P〉0．05）。结论AEG和LESC具有不同淋巴结转移规律，应采用不同的手术方式进行治疗。SiewertⅠ型和Ⅱ型AEG需重视中下纵隔淋巴结的清扫。

Objective To compare the differences in biological behavior and clinical features between adenocarcinoma of the esophagogastric junction（AEG） and lower thoracic esophageal squamous cell cancer （LESC）, and to explore reasonable procedures for each cancer. Methods Clinical data of Ⅲ patients with AEG and 126 patients with LESC who underwent surgery from January 2004 to April 2012 were retrospectively reviewed. Data pertaining to resection rate, lymph node metastasis, and postoperative complication rate were analyzed. Results The resection rate was 94.6% for AEG and 97.6% for LESC, and the difference was not statistically significant （P〈O.05）. The rate of lymph node metastasis in the mediastinum in patients with AEG was significantly lower E6.3% （7/111） vs. 32.5% （41/126）, P〈0.01], while the rate of lymph node metastasis in the abdomen was significantly higher [ 57.7% （64/111 ） vs. 34.1% （43/126）, P〈O.O1 ]. The rate of lymph node metastasis in mediastinum of AEG was 12.5%（4/32） for Siewert I and 4.7%（3/64） for Siewert Ⅱ , and there was no lymph node metastasis in SiewertⅢ （n=15）. For AEG patients who underwent trans-abdominal surgery, the rate of positive lymph node in the middle and lower mediastinum was significantly lower than trans-thoracic surgery [0/22 vs. 7.9% （7/89）, P〈0.05]. LESC via right thorax with two-field or three-field lymph node dissection was associated with a significantly higher rate of positive lymph node metastasis in the upper mediastinum than that of single incision via left thorax [ 17.9%（12/67） vs. 0/59, P〈0.01 ]. The postoperative complication rates were 23.4% （26/111） and 27.0% （34/126） respectively, and the difference was not statistically significant （P〉0.05）. Conclusions AEG and LESC show different lymph node metastasis pattern and should be operated differently. Lymphadenectomy in mid-lower mediastinum should be emphasized in Siewert Ⅰ and Siewert Ⅱ type cancers.