胸段食管癌喉返神经旁淋巴结转移特点及临床意义

目的 探讨胸段食管癌喉返神经旁淋巴结转移特点及临床发生率,为术后准确分期、制定后续治疗方案和判断预后提供依据.方法 回顾性分析2007年3月至2010年2月,124例行胸段食管癌切除合并喉返神经旁淋巴结清扫术病人的临床和病理资料.结果 124例中34例出现了喉返神经旁淋巴结转移,34例共清扫了297枚淋巴结,47枚淋巴结有转移,其转移率为27.41%(34/124例),转移度为15.82%(47/297枚).34例有转移者中,高分化食管癌4例,中分化食管癌13例,低分化食管癌17例;低分化食管癌比高、中分化食管癌更易发生喉返神经旁淋巴结转移.上段食管癌9例、中段20例、下段5例,上段食管癌喉返神经旁淋巴结转移率为30%,中段为29%,下段为20%,上、中段食管癌喉返神经旁淋巴结转移率明显高于下段食管癌;T2 6例,T1 27例,T2的转移率为23.08%(6/26例),T3的转移率为28.72%(27/94例),两组转移率基本相似,P>0.05.11例术后出现声嘶,发生率为8.87%(11/124例),7例3个月后恢复.结论 胸段食管癌病例有近1/3发生喉返神经旁淋巴结转移,尤其是胸上段、低分化、浸润深(T2 以上)的食管癌更易发生.

Abstract：

Objective To investigate the clinical significance and characteristics of recurrent laryngeal nerve lymph node metastasis of thoracic esophageal cancer.Methods One hundred and twenty-four patients who had undergone thoracic esophageal resection with recurrent laryngeal nerve lymph node dissection in our hospital from March 2007 to February 2010.All clinical data were retrospectively analysed.Results Recurrent laryngeal nerve lymph node metastasis was found in 34 of 124 cases,with the metastatic rate of 27.41% (34/124).The left recurrent laryngeal nerve lymph node metastasis was 16.13% and the right was 8.06% .The recurrent laryngeal nerve lymph node metastasis was found in 9 patients with the upper segment esophageal cancer,20 with middle third esophageal cancer and 5 with lower segment esophageal cancer,6 patients with T2 disease had recurrent laryngeal nerve lymph node metastasis,while 27 with,T3 disease.Also there were 4,13,17 cases with metastasis in well-differentiated,moderately differentiated,poorly differentiated respectively.Poorly differentiated esophageal carcinoma was more susceptible to recurrent laryngeal lymph node metastasis than well-differentiated and moderately differentiated esophageal carcinoma.Recurrent laryngeal nerve injury was found in 11 cases,7 cases of them recovered.Conclusion Nearly 1/3 of patients with esophageal carcinoma have recurrent laryngeal nerve lymph node metastasis,especially for tumor located in the upper third esophagus,poor differentiation or deep invasion (T2 or more) of esophageal carcinoma were more susceptible to recurrent laryngeal nerve lymph node metastasis.     

影响T1～2期结直肠癌淋巴结转移和预后的因素分析

Objective To investigate factors associated with lymph node metastasis and prognosis in patients with T1-2 colorectal cancer. Methods Patients with pT1-2 colorectal cancer between January 1999 to January 2005 were included. Chi-square test and multivariable logistic analysis were performed to evaluate risk factors associated with lymph node metastasis. Survival outcomes were analyzed using Kaplan-Meier and Cox regression model. Results Tumor location and depth of invasion were independent risk factors for lymph node metastasis (P＜0.01 and P＜0.05). Gender, age, tumorgross pattern, tumor differentiation, carcinoembryonic antigen level, and tumor diameter were notassociated with lymph node metastasis. Lymph node metastasis and distant metastasis on postoperative follow-up were independent risk factors for survival (P＜0.05 and P＜0.01). Conclusion Factors associated with lymph node metastasis in pT1-2 colorectal cancer do not affect the survival. However,lymph node metastasis and distant metastasis are predictive for survival.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

盆腔侧方淋巴结转移对低位直肠癌预后的影响

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients (18.8%), and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39.4% in obturator nodes. Age ≤40 years, infiltrative cancer, T3-4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer (P ＜ 0.05). The overall 5-year survival rate was 64.1%, and it was 94.1%, 79.1%, 42.1% for patients with TNM stage Ⅰ , Ⅱ , Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis (P ＜ 0.05). The 5-year survival rate of the patients without lateral metastasis was 73.6%, which was significant higher than that of patients with lateral metastasis (21.4%, P ＜0.05). Conclusion Lateralpelvic lymph node metastasis is an important prognostic factor for low rectal cancer.     

Pattern of lymph node metastases in patients with squamous cell carcinoma of the thoracic esophagus who underwent three-field lymphadenectomy

BACKGROUND/AIMS: Lymph nodes in patients with squamous cell carcinoma of the thoracic esophagus might be involved with metastases at cervical, mediastinal, and abdominal sites. The range of lymph node dissection is still controversial. The pattern of lymph node metastasis and factors that are correlated with lymph node metastasis affect the surgical procedure of lymph node dissection. The purpose of the present study was to explore the pattern of lymph node metastasis and factors that are correlated with lymph node metastasis in patients with esophageal cancer who underwent three-field lymphadenectomy. METHODS: Lymph node metastases in 230 patients who underwent radical esophagectomy with three-field lymphadenectomy were analyzed. The metastatic sites of lymph nodes were correlated with tumor location by chi-square test. Logistic regression was used to analyze clinicopathological factors related to lymph node metastasis. RESULTS: Lymph node metastases were found in 133 of the 230 patients (57.8%). The average number of resected lymph nodes was 25.3 +/- 11.4 (range 11-71). The proportions of lymph node metastases were 41.6, 19.44, and 8.3% in neck, thoracic mediastinum, and abdominal cavity, respectively, for patients with upper thoracic esophageal carcinomas, 33.3, 34.7, and 14%, respectively, in those with middle thoracic esophageal carcinomas, and 36.4, 34.1, and 43.2%, respectively, for patients with lower thoracic esophageal carcinomas. We did not observe any significant difference in lymph node metastatic rates among upper, middle, and lower thoracic carcinomas for cervical or thoracic nodes. The difference in lymph node metastatic rates for nodes in the abdominal cavity was significant among upper, middle, and lower thoracic carcinomas. The lower thoracic esophageal cancers were more likely to metastasize to the abdominal cavity than tumors at other thoracic sites. A logistic regression model showed that depth of tumor invasion and lymphatic vessel invasion were factors influencing lymph node metastases. CONCLUSIONS: Based on our data, cervical and mediastinal node dissection should be performed independent of the tumor location. Abdominal node dissection should be conducted more vigorously for lower thoracic esophageal cancers than for cancers at other locations. Patients with deeper tumor invasion or lymphatic vessel invasion were more likely to develop lymph node metastases.     

胸段食管鳞癌淋巴结转移规律探究

目的探讨胸段食管鳞癌淋巴结转移规律及其影响因素,以指导淋巴结清扫方式。方法回顾分析漳州市医院2010年4月至2012年7月手术治疗的328例胸段食管鳞癌的临床病理资料,探讨淋巴结转移规律及其影响因素。结果全组328例共清扫淋巴结9937枚,平均30．3枚／例。共437枚、153例有淋巴结转移,转移率46．65％;其中喉返神经旁淋巴结转移18．30％,10．46％喉返神经旁淋巴结为唯一转移部位。胸段食管癌淋巴结转移与肿瘤部位、长度、分化程度及浸润深度明显相关。胸上段食管癌淋巴结转移方向主要向上纵隔及下颈部;胸中段食管癌颈、胸、腹均可发生淋巴结转移;胸下段食管癌主要向腹腔、中下纵隔转移。结论食管上段鳞癌,颈部淋巴结转移率高,应行三野淋巴结清扫;下段食管癌清扫重点在腹腔、中下纵隔;中段鳞癌应提倡进行个体化清扫和适度清扫;分化程度差,浸润程度深的病例应适当扩大清扫范围。胸段食管癌喉返神经旁淋巴结转移率高,均应行喉返神经旁淋巴结清扫。     

选择性颈胸腹三野淋巴结清扫治疗胸段食管鳞癌

目的 研究胸段食管鳞癌的淋巴结转移规律，探讨合适的淋巴结清扫范围。方法 87例接受食管次全切除术的胸段食管鳞癌患者，根据术前食管腔内超声和颈部超声检查结果，选择性进行胸腹二野或颈胸腹三野淋巴结清扫。结果 超声发现颈部淋巴结肿大并行三野清扫35例（40．2％，三野清扫组），其中原发肿瘤位于胸上段食管者的比例（16／24例，66．7％）显著高于中、下段肿瘤者（19／63例，30．2％）（P=0．002）。三野清扫术扫除淋巴结13．7组／例，显著多于二野清扫组（52例，59．8％）的10．5组／例（P〈0．001）。术后病理检测三野清扫组转移淋巴结1．5组／例，也显著多于二野清扫组的0．8组／例（P〈0．01）。颈淋巴结转移（pM1-LN）17例（占全组19．5％，占三野清扫组48．6％），有区域淋巴结转移者的颈淋巴结转移比例（15／48例，31．3％）显著高于无区域淋巴结转移者（2／39例，5．1％）（P〈0．01）。上、中、下纵隔及上腹部的淋巴结转移率分别为25．3％、23．O％、5．7％和24．1％，颈淋巴结转移与上纵隔（P〈0．01）及中纵隔（P〈0．01）淋巴结转移显著相关，但与下纵隔及上腹部淋巴结转移无关。三野清扫组术后并发症发生率（60．0％）显著高于二野清扫组（34．6％，P=0．020）。喉返神经损伤发生率两组差异无统计学意义（P〉0．05）；但喉返神经损伤者吻合口瘘发生率（7／13例，53．8％）显著高于无喉返神经损伤者（10／74例，13．5％，P=0．001）。术后死亡率两组差异无统计学意义（P〉0．05）。结论 应对肿瘤位于胸上段食管、或上纵隔及中纵隔淋巴结已发生转移的食管癌患者在超声指导下进行选择性颈胸腹三野淋巴结清扫术，以降低手术风险、提高手术根治效果。     

胸中段食管鳞状细胞癌伴腹腔淋巴结转移及其预后的临床研究

目的 了解胸中段食管鳞状细胞癌伴腹腔淋巴结转移的方式,分析预后的影响因素.方法 对1998年1月至2003年1月接受手术治疗的368例胸中段食管鳞状细胞癌患者进行回顾性研究.本组男性289例,女性79例,年龄38～79岁,平均56岁.术前临床分期I～Ⅲ期.全部患者采用Ivor-Lewis手术(右胸及上腹部两切口)行食管大部切除加胸腹二野淋巴结清扫.全组患者平均随访时间68个月.结果 腹腔淋巴结转移58例(15.8%),其中T1-2患者占36.2%(21/58);有13.8%(8/58)的患者为跳跃性腹腔淋巴结转移,均发生在T1-2患者中.腹腔淋巴结转移患者5年生存率为10.3%,低于胸腔淋巴结转移患者的18.3%.远处腹腔淋巴结转移患者预后极差,无1例达到5年生存(0/16).COX多因素分析结果 显示,淋巴结转移数目≥5枚和远处腹腔淋巴结转移是腹腔淋巴结转移患者的独立预后因素.结论 胸中段食管癌腹腔淋巴结转移的发生率较高,应该选择有利于腹腔淋巴结广泛清扫的手术方式.腹腔淋巴结转移患者的预后不良,尤其淋巴结转移数目较多和远处淋巴结转移的患者预后更差.     

胸段食管癌颈部及上纵隔淋巴结转移

探讨胸段食管癌颈部及上纵隔淋结转移规律。方法采用颈,胸,腹三切口施行胸段食管癌手术６１６例,同时施行三区域淋巴洁清扫。结果：中及上纵隔淋巴结转移率和转移度分别为５７．１％和２１．５％。结论胸段食管癌必须重颈部及上纵隔淋巴结清扫。     

Abdominal Lymph Node Metastasis in Patients with Mid Thoracic Esophageal Squamous Cell Carcinoma

Background  There are few reports about abdominal lymph node metastasis of mid thoracic esophageal carcinoma. This study was designed to explore the pattern of abdominal lymph node metastasis in patients with mid thoracic esophageal squamous cell carcinoma and to evaluate the prognostic factors. Methods  The complete data of 368 patients with mid thoracic esophageal squamous cell carcinoma, who underwent modified Ivor-Lewis esophagectomy with two-field lymphadenectomy from January 1998 to January 2003, were reviewed. Survival rate was calculated by Kaplan-Meier method. Cox regression analysis was performed to identify risk prognostic factors. Results  Abdominal lymph node metastasis occurred in 58 (15.8%) patients: 34.5% (20/58) of them were stage T1 and T2. Skipping abdominal node metastasis was recognized in 13.8% (8/58) patients: all were stage T1 and T2. The overall 5-year survival rate of patients with abdominal lymph node metastasis (10.3%) was lower than that of those with thoracic node metastasis (18.3%). The prognosis of patients with distant abdominal lymph node metastasis was poor, and no one could survive more than 5 years. Cox regression analysis showed that five or more positive nodes and distant abdominal node metastasis were independent risk factors of patients with abdominal lymph node metastasis. Conclusions  Abdominal lymph node metastasis in patients with mid thoracic esophageal squamous cell carcinoma occurred frequently, and the surgery favorable for extensive abdominal lymph node dissection should be selected. The prognosis of patients with abdominal lymph node metastasis was poor, especially those with more positive nodes and distant abdominal node metastasis.     

Preoperative mapping of lymphatic drainage from the tumor using ferumoxide-enhanced magnetic resonance imaging in clinical submucosal thoracic squamous cell esophageal cancer

BACKGROUND: In thoracic esophageal cancer, lymph node metastases distribute widely from the neck to the abdominal area as a result of a complex periesophageal lymphatic network. The aim of the present study was to evaluate the potential clinical utility of a new method of mapping lymphatic drainage from tumors using ferumoxide-enhanced magnetic resonance imaging (MRI). METHODS: Twenty-three patients with clinical submucosal thoracic squamous cell esophageal cancer were examined. Ferumoxides were injected endoscopically into the peritumoral submucosal layer, after which their appearance in the lymph nodes in the neck, superior mediastinum, and abdomen was evaluated using MRI. RESULTS: Flux of ferumoxides from tumors was detected in all 23 patients. Among the 20 patients with middle and lower thoracic esophageal cancers, there was no lymphatic drainage to the neck in 5 (25%) patients, none to the neck and superior mediastinum in 4 (20%), and none to the abdomen in 2 (10%), which could enable the extent of lymph node dissection to be reduced. We diagnosed clinical negative lymph node metastasis (N0) in 17 patients; the remaining 6 patients were diagnosed with clinical lymph node metastasis. Two patients (12%) diagnosed clinical N0, showed pathologic lymph node metastasis. Ferumoxide-enhanced MRI detected an influx of contrast agent into the metastatic node in both patients. CONCLUSIONS: Ferumoxide-enhanced MRI lymphatic mapping enables detection of the direction and area of lymphatic flux. It thus has the potential to improve our ability to gauge the appropriate extent of treatment in clinical submucosal squamous cell esophageal cancer.     

Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus: comparing the short- and long-term outcome among the four types of lymphadenectomy

Abstract Controversy continues over the optimal extent of lymphadenectomy (regional versus three-field) for a potentially resectable squamous cell carcinoma in the thoracic esophagus. In the Consensus Conference of the International Society for Diseases of the Esophagus (ISDE), held in Munich in 1994, the types of lymphadenectomy were classified as standard, extended, total, or three-field lymphadenectomy. The objective of the present study was to determine the optimal procedure among these four types of lymphadenectomy. The mortality and morbidity rates, postoperative course, and survival rates were compared among 302 patients who underwent curative (R0) transthoracic esophagectomy with one of these four types of lymphadenectomy at Kurume University Hospital, Fukuoka, Japan, from 1986 to 1998. Three-field lymphadenectomy resulted in better survival than any other type of lymphadenectomy for patients with positive lymph node metastasis from a cancer in the upper or middle thoracic esophagus. A postoperative complication, such as recurrent laryngeal nerve paralysis, anastomotic leakage, and tracheal ischemic lesion, was significantly more common after three-field lymphadenectomy. However, the mortality rate was the same among the four procedures. Three-field lymphadenectomy was optimal for an upper or middle thoracic esophageal cancer with metastasis in the lymph node(s) based on improved long-term survival, whereas there was not a large difference in short-term and long-term outcomes after the four types of lymphadenectomy for a lower thoracic esophageal cancer. Electronic Publication     

N1期食管鳞癌淋巴结转移规律及预后分析

目的：探讨N1期食管鳞癌淋巴结转移规律及其与预后的关系。方法回顾性分析2005年1月至2008年12月间天津医科大学肿瘤医院行食管癌根治术且术后病理诊断为N1期（1～2枚淋巴结转移）的126例患者的临床及随访资料,分析各组淋巴结转移情况及其对预后的影响。结果126例患者中仅1枚淋巴结转移者70例,2枚淋巴结转移者56例。上纵隔淋巴结、中下食管旁淋巴结、贲门周围淋巴结和胃左动脉旁淋巴结的早期转移率较高,分别为53．8％（14/26）、38．3％（41/107）、34．5％（30/87）和36．8％（39/106）。隆突下淋巴结转移（P＝0．031）和中下食管旁淋巴结转移（P＝0．042）是影响食管鳞癌早期淋巴结转移患者的独立预后因素。隆突下淋巴结转移者5年生存率明显低于其他部位淋巴结转移者（8％比26％,P＝0．004）;而仅中下食管旁淋巴结转移者5年生存率则明显高于其他部位淋巴结转移者（33％比12％,P＝0．029）。结论 N1期食管鳞癌淋巴结易转移至上纵隔、中下食管旁、贲门周围和胃左动脉旁淋巴结等部位,而隆突下及中下食管旁淋巴结转移是N1期患者的独立预后因素。     

The treatment of lymph node metastasis from esophageal cancer by extensive lymphadenectomy

During the period between 1965 and the end of 1988, 560 patients with esophageal cancer were surgically treated in our University hospital. In an attempt to improve patient survival, three-field lymphadenectomy of the bilateral neck, mediastinum and abdomen was performed in 117 patients treated since 1983. The present study was undertaken to reveal the substantial rate of lymph node metastasis in esophageal cancer and to decide if three-field lymphadenectomy is mandatory or not for surgery of esophageal cancer. Despite the increased radicality of the operation, the mortality and morbidity rates decreased in the 1980's compared to the earlier periods, the operative death being 12.5 per cent in the 1960's, vs. 2.0 per cent in the 1980's. Moreover, the mortality rate of the patients receiving the three-field lymphadenectomy was as low as 2.6 per cent. The metastatic rate of cervical nodes in the patients receiving three-field lymphadenectomy was 32.5 per cent, while that of mediastinal and abdominal nodes was 47.0 per cent and 46.0 per cent respectively. The metastatic rate in the mediastinum was high in the bilateral recurrent nerve lymph nodes, bifurcation nodes and paraesophageal nodes, while in the abdomen, it was high in the bilateral paracardial nodes. Recurrent nerve paralysis, which had been rarely seen was observed in 12.0 per cent of the patients. Metastasis from esophageal cancer is often seen in the cervical nodes, however, the clinical importance of three-field lymphadenectomy will be decided by the data of patient survival in the near future.