Clinical research on thoraco-abdominal two-field lymph node dissection and regularity of metastasis in middle-third thoracic esophageal carcinoma / 中国综合临床

ABSTRACT

Objective To investigate the regularity of thoraco-abdominal two-field lymphatic metastasis and methods of the nodal dissection in middle-third thoracic esophageal carcinoma,and to guide the scope of the lymph-node clearance.Methods Thoraco-abdominal two-field lymph-node dissection based on surgical incisions of the right chest and middle upper abdomen were conducted in 62 cases with middle-third thoracic esophageal cancer and the regularity of nodal metastasis was analyzed.Results Five hundred and five pieces of lymph node were cleaned in all 62 patients and among them 102 pieces were detected as metastasis lymph node,the nodal metastasis ratio was 20.2％ (102/505).The middle-third thoracic esophageal cancer not only includes the nodal metastases up to the trachea of the right neck,around the bilateral recurrent laryngeal nerve chains,near the esophagus and the tumor,and the lymph-node metastasis at the inferior tracheal protuberance,but also the nodal metastases down to the cardiac,around the left gastric artery and at the retina of the lesser curvature of the stomach etc,presenting a tendency of 2-way metastasis.The infiltration depth and differentiation of the tumor is of statistical significance on the nodal metastasis ratio.There was significant difference on the metastasis rate of lymph node from T1 to T4 (T110.0％ (1/10),T220.0％ (3/15),T343.3 ％ (13/30),T457.1％ (4/7),x2 =18.56,P ＜ 0.05).It indicated that metastasis rate was increased with the development of the infiltration depth.There was significant difference on the metastasis rate of high differentiation carcinoma,moderate differentiation carcinoma and low differentiation carcinoma (14.3％ (2/14) vs 39.5％ (15/38) vs 57.1％(4/7),x2 =17.75,P ＜ 0.05).Conclusion The lymph node metastasis of patients with middle-third thoracic esophageal carcinoma is significantly correlated with the depth of tumor invasion and the degree of differentiation,with the tendency of thoraco-abdominal 2-field nodal metastasis.The peritracheal lymph node at right neck and bilateral recurrent laryngeal nerve chains are important regions of the metastasis.The surgical incision of the right thorax and upper abdomen greatly facilitates the excision of the middle-third thoracic esophageal cancer and the 2-field lymph node dissection Thus on this basis,the lymph node clearance around the right trachea and at bilateral recurrent laryngeal nerve chains through the right thoracic apex is safe and feasible.