ORIGINAL ARTICLES   

Panminerva Medica 2001 September;43(3):167-70

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Lymph node dissection in surgical treatment of esophageal neoplasms

Ruggieri M., Del Grammastro A., Mascaro A., Luongo B., Paolini A.

From the Department of Surgical Sciences, and Applied Medical Technologies, “La Sapienza” University, Rome, Italy

Background. Until now ther­a­py of car­ci­no­ma of the esoph­a­gus has pre­sent­ed an ­aura of pes­si­mism, result­ing in an atti­tude ­among phy­si­cians ­that ­cure was impos­sible. Presently the over­all 5-­year sur­vi­val is ­between 38.3% and 55% ­thanks to new rad­i­cal sur­gi­cal tech­niques. The aim of ­this ­work is to eval­u­ate ­lymph ­node dis­sec­tion in treat­ment of esoph­a­geal car­ci­no­ma by analyz­ing mor­bid­ity, mor­tal­ity, sur­vi­val and qual­ity of ­life.
Methods. From 1975 to 1995, 170 ­patients ­with car­ci­no­ma of the esoph­a­gus and car­dia under­went oper­a­tion, of ­whom 165 under­went 2-­field lym­phad­e­nec­to­my and four 3-­field lym­phad­e­nec­to­my; one ­patient was sub­mit­ted to self­tran­splant­ing jej­u­nal ­loop to ­neck. One hun­dred and twen­ty-two ­patients had “stan­dard” resec­tion and 47 “en ­bloc” resec­tion.
Results. Lymph ­node involve­ment is ­often ­found in ­patients ­with super­fi­cial car­ci­no­ma and it great­ly influ­enc­es out­come ­after esoph­a­gec­to­my. In 2-­field lym­phad­e­nec­to­my mor­bid­ity and mor­tal­ity are ­more fre­quent in “en ­bloc” resec­tions; glo­bal 3-­year sur­vi­val was bet­ter in ­patients ­with ear­ly ­lesions. Three-­field lym­phad­e­nec­to­my was per­formed in ­only few cas­es, not suf­fi­cient to ­express a defin­i­tive opin­ion.
Conclusions. On the ­basis of our expe­ri­ence, we con­clude ­that the bet­ter sur­vi­val is par­tic­u­lar­ly depen­dent on ear­ly diag­no­sis, his­to­log­i­cal ­type of neo­pla­sia and fol­low­ing sur­gi­cal treat­ment, espe­cial­ly on the ­type of resec­tion ­with 2 or 3-­field lym­phad­e­nec­to­my.