不同淋巴清扫术式对食管癌手术切除患者的疗效及并发症的影响

目的 探讨不同淋巴结清扫术式对食管癌手术切除患者近期、远期临床效果的影响.方法 回顾性分析接受食管癌根治术的268例患者临床资料.按淋巴结清扫方式不同分为标准二野组(n=121),全二野组(n=147),观察两组患者的淋巴结清扫情况、术后并发症、生存率及淋巴结复发情况.结果 标准二野组淋巴结转移率71.1％.全二野组淋巴结转移率63.3％,差异无统计学意义(P＞0.05);全二野组术后并发症发生率为17.0％ (25/147),明显高于标准二野组的5.8％(7/121),差异有统计学意义(x2=7.948,P＜0.01).标准二野组的5年生存率为29.8％,全二野组的5年生存率为28.6％,差异无统计学意义(x2=0.005,P＞0.05).标准二野组术后淋巴结复发率为41.3％ (50/121),远远高于全二野组的19.0％ (28/147),差异有统计学意义(x2=15.959,P＜0.01) .结论 与标准二野淋巴清扫术相比,全二野淋巴清扫并未提高食管癌患者术后生存,相反还带来了更高的并发症风险.     

不同淋巴结清扫范围的胃癌根治手术对机体的侵袭

Objective： To evaluate the effects of surgical trauma of open surgery on the patients with gastric carcinoma who underwent different lymph node dissection. Methods： Total 30 patients with gastric carcinoma were divided into three groups （D1, D2, and D3） according to the extent of lymph node dissection. Peripheral blood samples were taken to measure the levels of interleukin-6 （IL-6）, interleukin-8 （IL-8）, C-reactive protein （CRP） and polymorphonuclear elastase （PMNE）. Ad- ditionally, leucocytes and lymphocytes counts in peripheral serum were also detected. Results： All the three groups showed a significant increase of the levels of IL-6, IL-8, CRP and PMNE after operation. There was no significant difference between D1 and D2 groups. When the comparison was made between D3 group and the other two groups, it showed higher concentration of IL-6, IL-8, CRP and PMNE in serum of D3 group. Leucocytes count showed no difference among the three groups. After operation, the patients in three groups had transient lymphocytes decrease on the second and third postoperative days, the lymphocytes count in D3 group was still lower while those in D1 and D2 groups began to increase. Conclusion： IL-6, IL-8, CRP and PMNE can be used to monitor surgical stress. Using these parameters, we found that extended lymph node dissection of D3 group led to more postoperative stress than D1 and D2 groups.     

进展期胃癌淋巴结清扫范围探讨

目的 探讨进展期胃癌淋巴结清扫范围的合理性。方法 对６７例进展期胃癌患者施行了包括第１６组淋巴结清扫在内的扩大根治术。结果 Ｎ１淋巴结转移发生率为９２．５％、Ｎ２为６２．７％、Ｎ３为３１．３％、第１６组也达到２３．９％。结论 作者复习有关文献,分析此组资料认为对进展期胃癌肿瘤侵犯浆膜层,肿瘤范围较大,ＢｏｒｒｍａｎｎⅡ、Ⅲ型,组织分化不良以及Ｎ１、Ｎ２淋巴结转移较多的患者应选择施行包括第１６组淋巴     

不同淋巴结清扫术式对老年胸中上段食管癌患者淋巴结转移复发率、生存时间及并发症的影响

目的 研究二野淋巴结清扫根治术和三野淋巴结清扫根治术对老年胸中上段食管癌患者淋巴结转移复发率、生存时间及并发症的影响.方法 选择2010年1月至2013年6月接受手术治疗的老年胸中上段食管癌患者120例.用随机数表法分为二野组和三野组,每组各60例,二野组患者行二野淋巴结清扫根治术,三野组患者行三野淋巴结清扫根治术。比较2组患者的淋巴结转移复发率、生存率和并发症.结果 三野组患者的淋巴结平均清扫枚数和淋巴结转移率高于二野组,颈淋巴结复发率低于二野组,差异有统计学意义(P＜0.05);2组患者的纵膈淋巴结复发率比较差异无统计学意义(P＞0.05).三野组患者的1年生存率、2年生存率和3年生存率分别为95.00％、83.33％、68.33％,明显高于二野组,差异有统计学意义(P＜0.05).三野组患者的喉返神经损伤和吻合口痿发生率高于二野组,差异有统计学意义(P＜0.05);2组患者的呼吸系统并发症、心血管并发症和胸腔感染发生率比较差异无统计学意义(P＞0.05).结论 三野淋巴结清扫根治术可以更为彻底地清除老年胸中上段食管癌患者的淋巴结,降低局部复发率,提高生存率,但喉返神经损伤和吻合口瘘发生率较高.     

胸段食管癌清扫淋巴结数对生存率的影响

长期以来,胸段食管癌以清扫全胸段食管淋巴结、隆突下、左右支气管旁淋巴结和胃贲门旁和胃左淋巴结的二野清扫为标准式而普遍应用.在不同医院或外科医师之间存在技术水平上的差别,清扫纵隔淋巴结的彻底程度上也存在差异.如何界定清扫的彻底程度是一个相当困难的问题,因其影响对术后辅助治疗的选择,尤其是淋巴结数少的情况下导致临床分期降期,放弃了恰恰需要进行术后放射的病例,对于预后的影响是不言而喻的.我们回顾分析101例食管癌手术病例,就纵隔淋巴结及胃周淋巴结清扫彻底程度的差异对生存率影响进行探讨,现报告如下.     

食管癌颈胸腹淋巴结清扫研究

目的：探讨食管癌颈胸腹淋巴结清扫的意义。方法：选取术后5年以上基本条件相同的资料分成两组：三野相组即颈胸腹淋巴结清扫和二野组即隆突以下胸腹淋巴结清扫进行对比分析。结果：三野组和二野组淋巴结转移率分别为60％和57．7％;淋巴转移度分别为8．7％和10．7％;肺部并发症发生率分别为4．78％和4％;手术死亡率分别为1．3％和2．2％;术后淋巴结转移复发率分别为9．7％和33．8％;5年生存率分别为40．9％和26．5％。结论：清除双侧喉近神经旁淋巴结对食管癌根治术十分重要。三野术较二野术根治性强,手术安全,可明显提高5年生存率。     

胸中段食管鳞癌淋巴结转移度及合理清扫范围的临床研究

目的:本研究通过分析胸中段食管鳞癌淋巴结转移规律及淋巴结转移度对预后的影响,探讨合理的淋巴结清扫范围.方法:对129例经现代二野淋巴结清扫术的胸中段食管鳞癌患者的临床资料进行回顾性分析.结果:全组患者淋巴结转移率为56.6%,总淋巴结转移度(阳性淋巴结数/清扫淋巴结总数,LMR)为11.3%,上纵隔淋巴结转移率为43.4%.最常见的淋巴结受累区域为食管旁、右喉返神经旁、贲门及胃左血管旁、隆突下.影响淋巴结转移的主要因素为肿瘤浸润深度、分化程度及肿瘤长度.无淋巴结转移组、淋巴结转移度≤20%组和淋巴结转移度>20%组患者5年生存率分别为50.4%、31.0%和6.8%,结果差异有统计学意义(P=0.000).结论:淋巴结转移度是判断食管癌预后的一个重要因素,胸中段食管癌应该常规行包括双侧上纵隔的现代二野淋巴结清扫术.     

两种纵隔淋巴结清扫方式治疗的219例ⅢA期非小细胞肺癌患者生存分析

背景与目的:在可切除的ⅢA期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者手术治疗中,如何正确处理纵隔淋巴结对预后非常关键,目前国内外学者对ⅢA期NSCLC患者纵隔淋巴结的清扫范围有较大争议.本研究目的在于探讨以两种纵隔淋巴结清扫方式对NSCLC患者生存的影响.方法:回顾性分析1999年1月至2004年1月,在新疆医科大学附属肿瘤医院外科行完全性切除术的219例ⅢA期NSCLC患者的临床资料及生存状况,其中109例采用采样式纵隔淋巴结清扫术(mediastinal lymph node sampling,LS),110例采用系统纵隔淋巴结清扫术(systematic mediastinal lymphadenectomy,SML).寿命表法和Kaplan-Meier法比较累积生存率及中位生存时间,Cox多因素生存模型分析影响生存的主要因素.结果:LS组患者术后1、3、5年生存率分别为82%、28%、13%,SML组分别为88%、37%、16%,两组术后中位生存期分别为20.0、23.5个月,有统计学意义(P＜0.05).Cox多因素分析结果表明,病理类型、纵隔淋巴结转移状况、纵隔淋巴结清扫方式是影响ⅢA期NSCLC N1或N2转移患者预后的因素(P＜0.05).结论:对可手术治疗的ⅢA期NSCLC患者行系统性纵隔淋巴结清扫可以提高生存率.     

现代二野淋巴结清扫食管癌切除术的疗效分析

目的 探讨食管癌切除现代二野淋巴结清扫的手术疗效及临床实际应用价值.方法 1987年6月至2007年12月间,对1690例中下段及上段食管癌患者分别采用Ivor-Lewis术式和Akiyama术式进行现代淋巴结清扫治疗,总结胸腹二野淋巴结转移的发生率以及患者术后1、3、5和10年的生存率.结果 全组患者中,有淋巴结转移713例,转移率为42.2%(713/1690).胸部淋巴结转移665例,占39.3%(665/1690),其中有胸顶气管旁三角区淋巴结转移349例,占20.7%;后上纵隔淋巴结转移444例,占26.3%;下纵隔淋巴结转移307例,占18.2%.腹部淋巴结转移339例,占20.1%.全组患者术后有278例发生312例次各种并发症,并发症的发生率为16.4%(278/1690),其中以肺部并发症为主,共136例次,占43.6%.全组患者的手术死亡率为0.2%.全组患者术后1、3、5和10年生存率分别为88.2%(1388/1574)、63.5%(868/1367)、54.8%(705/1287)和30.8%(232/754).无淋巴结转移患者的5年生存率为76.2%(448/588),有淋巴结转移患者的5年生存率为36.8%(257/699).结论 食管癌切除采用Ivor-Lewis和Akiyama术式可良好地显露胸腹二野,淋巴结清扫彻底,特别是对后上纵隔喉返神经旁、右胸顶气管旁三角区淋巴结的清扫尤为便利.对有淋巴结转移的食管癌患者施行现代二野淋巴结清扫十分必要,能显著提高患者的术后5年生存率.     

全胸段食管切除对胸下段食管癌患者术后生存率影响的临床研究

目的:探讨全胸段食管切除与胸中下段食管切除对食管癌患者术后生存率的影响,确定食管癌根治术的最佳手术入路,提高患者手术后长期生存率。方法:我院胸外科1999年1月~2001年12月对193例胸下段食管癌患者,行左胸后外侧切口(Ⅰ组)67例,行左胸后外侧切口 左颈切口(Ⅱ组)65例,行三切口(Ⅲ组)155例,完成食管癌食管切除术、经食管床食管重建术。结果:Ⅰ组患者术后1、3和5年生存率分别为77·14%、78·43%和82·54%,Ⅱ组分别为62·62%、58·36%和61·09%,Ⅲ组分别为38·12%、39·32%和42·07%。三组患者术后1、3年生存率差异无统计学意义,P>0·05。Ⅰ、Ⅲ组间5年生存率差异有统计学意义,P<0·05。Ⅰ、Ⅱ组间及Ⅱ、Ⅲ间5年生存率差异无统计学意义,P>0·05。结论:胸下段食管癌病例采取三切口的手术入路,5年生存率高于左胸后外侧切口组,且与左胸 左颈二切口相比,长期生存率显示增高的趋势。对于胸下段食管癌病例,应选择三切口手术入路。     

食管癌手术治疗原则和淋巴结清扫

食管癌的外科治疗应在仔细评估肿瘤的进展程度和患者的功能状况基础上掌握手术指征和手术方式,通过根治性的手术切除达到准确的手术病理分期和良好的局部控制,并籍此提高生存率和生活质量.系统性淋巴结清扫是食管癌外科治疗中的重要手段,应根据食管癌淋巴转移的解剖和生物学行为特点选择规范、合理的清扫.如何正确解读新版国际食管癌临床病理分期、理解并遵循<中国食管癌规范化诊治指南>进行规范化的外科诊治是提高治疗效果的关键.     

胃癌各组淋巴结的转移特点及其在实施合理根治术中的指导意义

目的 总结胃癌1～16组淋巴结转移的规律,探讨其对实施合理胃癌根治手术的指导意义.方法 收集因胃癌行全胃切除术的73例患者的临床病理资料,淋巴结分组按照只本胃癌学会胃癌处理规约第13版进行,共分为16组,比较患者淋巴结转移率和转移度的差异.结果 淋巴结转移率由低到高排列为第15、13、16、14v、12、10、9、11、8、2.6、7、5、1、4、3组,其中第15组淋巴结的转移率为1.4%,第3组淋巴结的转移率为65.8%,差异有显著的统计学意义(P＜0.01).淋巴结转移度由低到高排列为第13、16、1、7、6、5、12、4、11、8.2、15、9、3、10、14v组,其中第13组淋巴结的转移度为10.7%,第14v组淋巴结的转移度为56.3%,差异亦有显著的统计学意义(P＜0.01).结论 胃癌全胃切除术时,对淋巴结转移率高的区域必须实施清扫;对转移度高的区域要实施完整清扫.第3组淋巴结活检阴性是缩小手术的绝对指征;第14v组淋巴结活榆阴件是缩小手术的相对指征,而活检阳性是扩大手术的相对指征;第13和16组淋巴结活检阳性是姑息于术的绝对指征,而活检阴性、同时第14v组淋巴结活检阳性则是扩大手术的绝对指征.     

Impact of splenic node dissection on short-term outcome and survival following esophagectomy

Background

The purpose of this study was to investigate the impact of splenic node dissection on short-term outcomes and survival after esophagectomy in patients with thoracic esophageal squamous cell carcinoma (ESCC).

Impact of increasing lymph node yield on staging,morbidity and survival after esophagectomy for esophageal adenocarcinoma

BackgroundExtended lymphadenectomy during esophagectomy for esophageal cancer may increase survival, but also increase morbidity. This study analyses the influence of lymph node yield after transthoracic esophagectomy for esophageal adenocarcinoma on the number of positive lymph nodes, pathological N-stage, complications and survival.Materials and methodsConsecutive patients undergoing transthoracic esophagectomy for esophageal adenocarcinoma between 2010 and 2020 were prospectively recorded (follow-up until January 2022). Lymph node yield was analyzed as continuous and dichotomous variable (≤30 vs. ≥31 nodes). The effect of lymph node yield on number of positive lymph nodes, complications, disease-free (DFS) and overall survival (OS) was assessed in multivariable regression analyses.Results585 patients were included. Median lymph node yield increased from 25 (IQR 20–34) in 2010 to 39 (IQR 32–50) in 2020. Higher lymph node yield was associated with more positive lymph nodes (≥31 vs. ≤30 IRR 1.39, 95%CI 1.11–1.75). In 258 (y)pN + patients, the percentage of (y)pN3-stage increased with 14% between patients with ≤30 and ≥ 31 lymph nodes examined (p 0.014). Higher lymph node yield was not associated with more complications. Superior survival was seen in patients with ≥31 vs. ≤30 lymph nodes examined [DFS: HR 0.73, 95%CI 0.58–0.93, OS: HR 0.71, 95%CI 0.55–0.93)].ConclusionsA lymph node yield of 31 or higher was associated with upstaging and superior survival after esophagectomy for esophageal adenocarcinoma, without increasing morbidity. Extended lymphadenectomy may therefore be regarded as an important part of the multimodal treatment of esophageal cancer.     

The impact of lymph node dissection and adjuvant chemotherapy on survival: A nationwide cohort study of patients with clinical early-stage ovarian cancer

IntroductionTo establish the impact of lymph node dissection and chemotherapy on survival in patients with early-stage epithelial ovarian cancer (EOC).MethodsAll Dutch patients with International Federation of Gynaecology and Obstetrics (FIGO) stage I–IIA and IIIA1 EOC between 2000 and 2012 were included. Data concerning age, stage, tumour grade, histological subtype, hospital type, lymph node dissection, adjuvant chemotherapy and survival were extracted from the Netherlands Cancer Registry.ResultsOf 3658 patients included, 1813 (49.6%) had lymph nodes removed. Relative survival of patients with lymph node dissection (including those with lymph node metastases) was significantly better than that of patients without, also after correcting for stage, tumour grade, histology and age (89% and 82%, respectively; relative excess risk [RER], 0.64; 95% confidence interval [CI]: 0.52–0.78). There was a positive correlation between the number of removed lymph nodes and overall survival (after excluding patients with lymph node metastases). Of patients with stage I–IIA EOC who had ≥10 lymph nodes removed, there was no difference in relative survival between those who received chemotherapy and those who did not (RER, 0.51; 95% CI: 0.15–1.64). This was also true for a subgroup of patients with high-risk features (stage IC and IIA and/or tumour grade 3 and/or clear cell histology [RER, 0.90; 95% CI: 0.46–1.99]).ConclusionAdequate dissection of at least 10 but preferably ≥20 lymph nodes should be standard procedure for the staging of early-stage EOC. Adjuvant chemotherapy after an adequate lymph node dissection does not seem to contribute to a better relative survival.     

食管癌淋巴结转移的临床病理因素

目的 探讨食管癌淋巴结转移的临床病理相关因素。方法 对204例食管癌根治标本进行统计,分析各主要临床病理改变与淋巴结转移关系。结果 204例食管癌中有淋巴结转移者89例,淋巴结转移率为43.6％。胸中段癌淋巴结转移率为48.0％,胸上段癌和胸下段癌的淋巴结转移率分别为32.0％和26.9％。髓质型和溃疡型淋巴结转移率分别为47.6％和56.0％,除缩窄型外其他类型转移率最高者为21.4％。男性患者淋巴结转移率为54.3％,女性淋巴结转移率为28.4％。浸润至黏膜层和黏膜下层者,未发现淋巴结转移,浸润至浅肌层、深肌层、纤维膜者淋巴结转移率分别为28.6％、45.6％和48.8％。以上四种因素中前后两者间比较差异均有显著性(P<0.05)。淋巴结转移率与年龄无关,也不随肿瘤大小的增加而增加。结论 男性食管胸中段癌患者淋巴结转移率较高,尤其当肿物为髓质型和溃疡型时最为显著。     

The impact of lymph node dissection on survival in patients with clinical early-stage ovarian cancer

ObjectiveTo estimate the impact of lymph node dissection on survival in patients with apparent early-stage epithelial ovarian cancer (EOC).MethodsWe conducted a retrospective review of patients with clinical stage I–II EOC. All patients underwent primary surgery at Sun Yat-sen University Cancer Center between January 2003 and December 2015. Demographic features and clinicopathological information as well as perioperative adverse events were investigated, and survival analyses were performed.ResultsA total of 400 ovarian cancer patients were enrolled, and patients were divided into 2 groups: 81 patients did not undergo lymph node resection (group A), and 319 patients underwent lymph node dissection (group B). In group B, the median number of removed nodes per patient was 25 (21 pelvic and 4 para-aortic nodes). In groups A and B, respectively, the 5-year progression-free survival (PFS) rates were 83.3% and 82.1% (p=0.305), and the 5-year overall survival (OS) rates were 93.1% and 90.9% (p=0.645). The recurrence rate in the retroperitoneal lymph nodes was not associated with lymph node dissection (p=0.121). The median operating time was markedly longer in group B than in group A (220 minutes vs. 155 minutes, p<0.001), and group B had a significantly higher incidence of lymph cysts at discharge (32.9% vs. 0.0%, p<0.001).ConclusionIn patients with early-stage ovarian cancer, lymph node dissection was not associated with a gain in OS or PFS and was associated with an increased incidence of perioperative adverse events.     

The optimal lymph node dissection in patients with adenocarcinoma of the esophagogastric junction

Objective

The aim of this study was to refine the optimal lymph node dissection in Western patients with adenocarcinoma of the esophagogastric junction (AEG).