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The Journal of Cardiovascular Surgery 1999 October;40(5):737-40

lingua: Inglese

Significance of ­three-­field lym­phad­e­nec­to­my for car­ci­no­ma of the tho­rac­ic esoph­a­gus ­based on ­depth of ­tumor infil­tra­tion, ­lymph ­nodal involve­ment and sur­vi­val ­rate

Tabira Y., Kitamura N., Yoshioka M., Tanaka M., Nakano K., Toyota N., Mori T.

From the First Department of Surgery, Kumamoto University School of Medicine Kumamoto City, Kumamoto, Japan


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Background. Significance of ­three-­field lymh­pad­e­nec­to­my for car­ci­no­ma of the tho­rac­ic esoph­a­gus was exam­ined ret­ro­spec­tive­ly ­based on ­depth of ­tumor infil­tra­tion, ­lymph ­nodal involve­ments and ­long-­term sur­vi­val.
Methods. One hun­dred and fif­ty-two con­sec­u­tive ­patients who under­went cura­tive esoph­a­gec­to­my for tho­rac­ic car­ci­no­ma invad­ing to sub­mu­co­sa (pT1) or deep­er ­layers of the esoph­a­geal ­wall ­from 1983 to 1996 ­were exam­ined. Sixty-six ­patients under­went ­three-­field lym­phad­e­nec­to­my (3F) and 86 under­went two-­field lym­phad­e­nec­to­my (2F). Survival ­curves ­were com­pared ­between 3F and 2F ­after strat­ifi­ca­tions accord­ing to ­depth of ­tumor infil­tra­tion, the num­ber of pos­i­tive ­nodes (0, 1 to 4, 5 or ­more), and pos­i­tive intra­tho­rac­ic recur­rent ­nerve-­chain ­nodes.
Results. Overall 5-­year sur­vi­val ­rate for 3F was 43.8%, ­while it was 30.2% for 2F (p=0.07). In 41 ­patients ­with pT1 can­cers, the 5-­year sur­vi­val ­rate for 3F was 55.7%, ­while it was 41.4% for 2F (p=NS). In ­patients ­with can­cers invad­ing to mus­cu­lar­is pro­pria (pT2), the 5-­year sur­vi­val ­rate for 3F was 49.4%, ­while it was 30.7% for 2F (p=0.06). In ­patients ­with ­tumors invad­ing to adven­ti­tia, ­there was no sig­nif­i­cant dif­fer­ence. In ­patients ­with one to ­four pos­i­tive ­nodes, the 5-­year sur­vi­val ­rates for 3F was 50.1%, ­while it was 24.1% for 2F (p=0.01). There was no sig­nif­i­cant dif­fer­ence in the sub­groups ­with no pos­i­tive ­nodes and ­five or ­more. In sub­groups ­with pos­i­tive recur­rent ­nerve-­chain ­nodes, the 5-­year sur­vi­val ­rate for 3F was 27.9%, ­while it was 0% for 2F (p=0.01).
Conclusions. Significance of ­three-­field lym­phad­e­nec­to­my was ­found in ­patients ­with one to ­four pos­i­tive ­nodes or pos­i­tive intra­tho­rac­ic recur­rent ­nerve-­chain ­nodes.

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