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【文摘发布】下咽和颈段食管癌的上纵隔淋巴结
authors: Shigeru Hirano, Kunihiko Nagahara, Sueyoshi Moritani, Morimasa Kitamura, Shin-ichi Takagita
source:The Annals of Otology, Rhinology & Laryngology. St. Louis: Apr 2007. Vol. 116, Iss. 4; Part 1. pg. 290, 7 pgs
Source typeeriodical
Objectives: Hypopharyngeal cancer (HPC) and cervical esophageal cancer (Ce) are aggressive tumors with a poor prognosis. Multiple lymph node metastases often occur in the upper mediastinum, as well as in the neck, and thus upper mediastinal dissection (MD) is crucial in improving the cure rate.However, excessive MD can increase postoperative morbidity and mortality, making it important to employ the proper technique and appropriate extent of dissection. In the present retrospective study we aimed to determine the proper extent of upper MD according to tumor site and stage. The benefit and risk of upper MD are also discussed.
Methods: Chart review was completed for patients who underwent upper MD, including 64 patients with HPC, 21 patients with Ce, and 9 patients with Ce extending to involve the upper thoracic esophagus (Ce/Ut). The incidence and distribution of lymph node metastases in the upper mediastinum were assessed by postoperative histopathologic examination, Postoperative complications of upper MD, as well as the impact on survival and locoregional control, were also reviewed.
Results: Upper mediastinal metastases were detected in 7.8% of HPC patients, 33.3% of Ce patients, and 55.6% of Ce/Ut patients. In HPC patients, mediastinal metastases were usually associated with T4 primary tumors (80%), whereas positive nodes in the upper mediastinum were detected regardless of T stage in both Ce and Ce/Ut.Only 1 Ce/Ut patient with a T4 tumor developed late nodal metastasis in the lower mediastinum. The 5-year disease-specific survival and locoregional control rates were 58.6% and 90.2% in HPC, 45.5% and 94.1％ in Ce, and 38.9% and 77.7% in Ce/Ut, respectively. Rupture of the greater vessels after MD was observed in 5 cases (5.3%).
Conclusions: The present results indicate excellent locoregional control rates following upper MD, while major complications such as arterial breakdown were rare. It is suggested that upper MD may be an essential and adequate procedure for patients with Ce or Ce/Ut tumors, and may also be required for cases of HPC with a T4 primary to improve locoregional control of the disease. Upper Mediastinal Node Dissection for Hypopharyngeal and Cervical Esophageal Carcinomas
下咽和颈段食管癌的上纵隔淋巴结清扫术
Objectives: Hypopharyngeal cancer (HPC) and cervical esophageal cancer (Ce) are aggressive tumors with a poor prognosis. Multiple lymph node metastases often occur in the upper mediastinum, as well as in the neck, and thus upper mediastinal dissection (MD) is crucial in improving the cure rate.目的：下咽癌和颈段食管癌是预后很差的侵袭性肿瘤。和颈部一样，上纵隔也经常发生多发淋巴结转移。因此上纵隔淋巴结清扫对提高治愈率很重要。 However, excessive MD can increase postoperative morbidity and mortality, making it important to employ the proper technique and appropriate extent of dissection.然而，过度的上纵隔清扫可增加术后的发病率和死亡率，为此需要选择正确的术式和适当的清扫范围。 In the present retrospective study we aimed to determine the proper extent of upper MD according to tumor site and stage. The benefit and risk of upper MD are also discussed.该回顾性研究的目的就是根据肿瘤的部位和分期来确定适当的上纵隔淋巴结清扫范围。同时也讨论了上纵隔淋巴结清扫的优势和风险。
Methods: Chart review was completed for patients who underwent upper MD, including 64 patients with HPC, 21 patients with Ce, and 9 patients with Ce extending to involve the upper thoracic esophagus (Ce/Ut). The incidence and distribution of lymph node metastases in the upper mediastinum were assessed by postoperative histopathologic examination, Postoperative complications of upper MD, as well as the impact on survival and locoregional control, were also reviewed.方法：为曾经行上纵隔淋巴结清扫的病人制作回顾性的图表，其中包括64例下咽癌，21例颈段食管癌，9例由颈段食管癌扩散到上胸段食管癌。上纵隔淋巴结转移的发生率和分布通过术后组织病理学来评定，上纵隔淋巴结清扫术的并发症以及对生存情况和局部区域转移控制的影响也进行了回顾。
Results: Upper mediastinal metastases were detected in 7.8% of HPC patients, 33.3% of Ce patients, and 55.6% of Ce/Ut patients. In HPC patients, mediastinal metastases were usually associated with T4 primary tumors (80%), whereas positive nodes in the upper mediastinum were detected regardless of T stage in both Ce and Ce/Ut.结果：7.8％的下咽癌病人、33.3％的颈段食管癌病人以及55.6％的颈胸段食管癌病人被发现有上纵隔转移。在下咽癌病人中，纵隔转移和T4原发肿瘤有关（80％）；而颈段和颈胸段食管癌经检查，上纵隔淋巴结阳性情况和T分期无关。Only 1 Ce/Ut patient with a T4 tumor developed late nodal metastasis in the lower mediastinum. The 5-year disease-specific survival and locoregional control rates were 58.6% and 90.2% in HPC, 45.5% and 94.1％ in Ce, and 38.9% and 77.7% in Ce/Ut, respectively. Rupture of the greater vessels after MD was observed in 5 cases (5.3%).仅有一例T4期颈胸段食管癌病人在稍下部的纵隔有晚期淋巴结转移。5年疾病相关生存率和局部区域控制率在下咽癌中为58.6％和90.2％，颈段食管癌中为45.5％和94.1％，颈胸段食管癌中为38.9％和77.7％。有5例（5.3％）在纵隔清扫术后出现大血管破裂。
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作者:admin@医学,生命科学 2011-05-24 05:11
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