食管癌根治术常规清扫隆突下淋巴结的价值

Value of routine subcarinal lymph node dissection in radical resection of esophageal cancer

目的探讨食管癌根治术是否需要常规清扫隆突下淋巴结。方法回顾性分析川北医学院附属医院2013年3月至2016年3月行食管癌根治术患者的临床资料,根据是否行隆突下淋巴结清扫分为清扫组(n=294)和未清扫组(n=308)两组。比较两组患者的基本特征,Logistic回归分析食管癌隆突下淋巴结转移的影响因素,并比较清扫组和未清扫组患者的围手术期差异。结果共纳入病例602例,平均清扫淋巴结11.75枚,其中淋巴结转移202例(33.6%)。清扫组患者平均清扫隆突下淋巴结2.87枚,其中转移20例(6.8%)。单因素分析显示:Tis/T1、T2、T3、T4期食管癌隆突下淋巴结转移率分别为0、1.4%、10.2%、13.6%(χ~2=16.407,P<0.01);N0、N1、N2、N3期食管癌隆突下淋巴结转移率分别为0、12.9%、20.5%、60.0%(χ~2=46.099,P<0.01);肿瘤长度≤3.0cm、3.1~5.0cm、>5.0cm食管癌隆突下淋巴结转移率分别为2.0%、7.5%、13.3%(χ~2=8.253,P<0.05);隆突下淋巴结转移与年龄、性别、手术路径、肿瘤位置、肿瘤分化程度以及淋巴结清扫数目无关(均P>0.05)。多因素分析显示:食管癌隆突下淋巴结转移与T分期及肿瘤浸润深度有关(均P<0.05)。清扫组患者肺部及胸腔并发症发生率高于未清扫组,手术时间长于未清扫组(均P<0.05)。结论食管癌隆突下淋巴结转移与肿瘤浸润深度及N分期有关。因此,对于胸段食管癌当肿瘤侵及食管纤维膜时建议行隆突下淋巴结清扫,但可能会增加肺部及胸腔并发症发生率并延长手术时间。

Objective To investigate the value of routine subcarinal lymph node dissection inradical resection of esophageal cancer. Methods The clinical data of patients undergoing radicil resection of esophageil cancer in Affiliated Hospitil of North Sichuan Medical College between March 2013 and March 2016were retrospectively analyzed. Patients were divided into dissection group （with subcarinal lymph node dissection, n=294） and non-dissection group （without subcarinll lymph node dissection, n = 308）. The basiccharacteristics were compared between two groups. The influencing factors ofsubcarinal lymph node metastasis were explored by Logistic regression analysis, and the perioperativeparameters were compared between two groups. Results A totll of 602 patients were included, with an average of 11.75 dissected lymph nodes in each patient. There were 202 cases of lymph node metastasis, which accounted for 33. 6%. The mean number of dissected mph nodes in eacgroup was 2.87, and there were 20 patients （6. 8%） with lymph node meunivariate analysis mdicated that the rates of subcarinal lymph node meT1, T2, T3 and T4 were 0, 1.4%, 10.2% and 13. 6%, respectively （χ^2 = 16.407, P 〈 0.01） , the rates of subcarinal lymph node metastasis in those staged N0, N1, N2 and N3were 0, 12.9%, 20.5% and 60. 0%, respectively （χ^2 = 46, 099, P 〈 0.01 ）, the rates of subcarinal lymph node metastasis in those with different length of esophageal cancers （〈3. 0 cm, 3.1 to 5.0 cm, 〉5.0 cm） were 2.0%,7.5% and 13. 3%, respectively （χ^2= 8. 253, P〈0.05 ） ,and the rate of subcarinal lymph nodemetastasis was not significantly related to age, gender, tumor location, surgical path, tumordifferentiation and number of dissected lymph nodes （P〉0. 05）. Multivariate analystaging and infiltration depth of esophageal cancer were related to subcarinal ymph node metastasis （P〈0. 05）. The incidence of pulmonary and thoracic cavity complications and operation time in dissectiongroup were higher and longer than those in non-dissection group （P 〈0. 05 ）. Conclusions Tumorinfiltration depth and N staging are related to subcarintl lymph node metastasis of esophagetl cancer.Subcarinal lymph nodes may be dissected routinely in esophageal cancer patienmembrane infiltration,however, it may also increase the incidence of complications and operation time.