Clinical analysis of lymphadenectomy in patients with esophageal carcinoma underwent single left thoracal incision and cervico-right thoracic-abdominal triple incision / 肿瘤研究与临床

ABSTRACT

Objective To explore the extent of lymphadenectomy by comparing the single left thoracotomy and cervico-right thoracic-abdominal triple incision during esophageal carcinoma radial surgery.Methods The clinical data of 95 patients with thoracic esophageal carcinoma underwent esophagectomy plus lymphadenectomy were studied.They were divided into two groups,left thoracotomy group(62 cases)and triple incision group(33 cases).The rates of lymph node metastasis and postoperative complications were analyzed statistically.Results A total of 1322 lymph nodes were dissected with an average of 13.9 lymph nodes in each case.The rates of lymph node metastasis were 45.3 ％(43/95)of all patients,40.3 ％ of left thoracotomy and 54.5 ％ of triple incision.The rates of lymph node metastasis in the neck for patients with upper or middle thoracic esophageal carcinoma were 25.0 ％(2/8)and 40.0 ％(4/10).The rate of abdominal lymph node metastasis was 53.8 ％(7/13)in lower thoracic carcinoma.The depth of tumor invasion (r =0.315,P =0.007)and tumor differentiation(r =0.239,P =0.017)were correlated to lymph node metastasis.Patients with tumor length ＞2 cm had higher rates of lymph node metastasis(x2 =34.2,P ＜ 0.001).The postoperative complication rates of left thoracotomy and triple incision were 25.8 ％(16/62)and 4.2 ％ (8/33).The mortalities rates of left thoracotomy and triple incision were 1.6 ％(1/62)and 3.0 ％(1/33).There was no significant difference in postoperative complication rates(x2 =0.017,P =0.869)and mortalities rates(x2 =0.047,P =0.651)between the two groups.Conclusion Tumor invasion,differentiation and length should be incorporated in the evaluation of lymph node status.Patients with upper and middle thoracic esophageal carcinoma should receive cervico-right thoracic-abdominal triple incision.Particular attention should be given to the resection of abdominal lymph nodes in patients with lower thoracic esophageal carcinoma.