右胸入路三野清扫淋巴结治疗中晚期胸中段食管癌的疗效及预后观察

Obsevation on the Clinical Effect and Prognosis of 3-field Lymphadenectomy by Right Transthoracic Approaches for Advanced Middle Thoracic Esophagus Cancer

目的:探讨右胸入路三野清扫淋巴结治疗中晚期胸中段食管癌的临床疗效及对预后的影响。方法:回顾性分析我院2012年9月-2013年9月收治的中晚期胸中段食管癌者的临床资料,所有患者均采用右胸入路行Ivor-Lewis术,根据淋巴清扫范围方式分为二野组(n=37)、三野组(n=25)。比较两组淋巴清扫情况、术后并发症、复发转移及预后。结果:与二野组比较,三野组淋巴清扫数显著增加(P<0.05),上纵膈淋巴结转移率及总转移率显著升高(P<0.05);二野组喉返神经损伤的发生率显著低于三野组(P<0.05);二野组和三野组的复发率分别为43.2%、16.0%,二者比较差异有统计学意义(P<0.05);三野组中位DFS为19.7个月(95%CI:15.5~23.8),显著高于二野组中位DFS为16.8个月(95%CI:12.0~20.9)(P<0.05)。结论:右胸入路三野淋巴结清扫治疗中晚期胸中段食管癌患者是安全可行的,有助于彻底清除转移淋巴结,降低术后复发,改善预后。

Objective： To explore the clinical effect and prognosis of 3-field lymphadenectomy by right transthoracic approaches for advanced middle thoracic esophagus cancer. Methods： The clinical data of 62 cases of advanced middle thoracic esophagus cancer who were treated in our hospital from 2012.9 to 2013.9 were retrospectively analyzed. All the patients were given Ivor-Lewis by right transthoracie approaches and divided into 2-field lymphadenectomy （n=37） and 3-field lymphadenectomy （n=25） according to the lymphadenectomy range. The lymphadenectomy postoperative complications, recurrence and metastasis, prognosis between two groups were compared. Results： Compared with 2-field group, the number of lymph nodes resected was increased in 3-field group （P〈0.05）, the upper mediastinal lymph node metastasis rate and total metastasis rate were significantly increased （P〈0.05）. 2-field group had significantly lower incidence of laryngeal recurrent nerve injury than 3-field group （P〈0.05）. The recurrence rate in 2-field group and 3-field group were 43.2% and 16.0%, respectively （P〈0.05）. The Median DFS in 3-field group was 19.7 months （95% CI： 15.5-23.8）, which was significantly higher than that in 2-field group 16.8 months （95% CI： 12.0-20.9） （P〈0.05）. Conclusions： It was safe and feasible of 3-field lymphadenectomy by right transthoracic approaches for advanced middle thoracic esophagus cancer, which could contribute to completely eliminate metastasis lymph nodes, reduce the postoperative recurrence and improve the prognosis.