Metastasis Feature and Dissecting Value of Cervicothoracic Lymph Node for Middle Esophageal Squamous Carcinoma: A Prospective Cohort Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 MAOZhi-ming ¹ , GUXiao-hua ¹ , LIChang-yan ² , ZHUDong-bing ³ , HUANGHai-sheng ⁴ , MAOWang-shan ¹ , ZHANGTao ¹ , SUNJian ¹ , ZHAOYang ⁵

1. Department of Thoracic Surgery, Rugao Boai Hospital, Rugao 226500 Jiangsu, P. R. China;
2. Department of Thoracic Surgery, Rugao People's Hospital, Rugao 226500 Jiangsu, P. R. China;
3. Department of Pathology, Rugao People's Hospital, Rugao 226500 Jiangsu, P. R. China;
4. Department of Pathology, Rugao Boai Hospital, Rugao 226500 Jiangsu, P. R. China;
5. Department of Epidemiology and Health Statistics, The Public Health College of Nanjing, Medical University, Nanjing 211166, P. R. China;

Corresponding author：

MAOZhi-ming, Email: Rgsmzm@126.com

Keywords：

Esophageal carcinoma; Esophagogastrostomy; Lymph node dissection; Cervicothoracic junction; Prospective cohort study

DOI：

10.7507/1007-4848.20150256

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Objective To evaluate the metastasis feature and the dissecting value of cervicothoracic lymph node for middle esophageal squamous carcinoma. Methods A total of 303 patients admitted to the Rugao Boai Hospital(107 patients) and the Rugao People's Hospital (196 patients) received the stapled cervical esophagogastrostomy via different thoracic approach according to the admission order number between March 2005 and February 2013. There were 290 patients with Ro resections including 149 patients by Ivor-Lewis approach (an Ivor-Lewis group) and 141 patients by Sweet approach (a Sweet group). The data of lymph nodal dissection and PTNM stage and follow-up of the two groups were analyzed. Results The number of positive lymph nodes dissected from the cervicothoracic junction in the IvorLewis group was significantly greater than that in own upper abdomen (Z=3.12, P<0.05) and that in the cervicothoracic junctionin in the Sweet group (Z=3.30, P<0.05). The lymph node metastasis rate of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen(χ²=10.76, P<0.05)and that in the cervicothoracic junction in the Sweet group (χ²=7.34, P<0.05). The lymph node ratio (LNR) of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen (χ²=11.67, P<0.05) and that in the cervicothoracic junction in the Sweet group (χ²=5.99, P<0.05). The proportion of patients which PTNM were Ⅲa or Ⅲb as N＞N₁ in the Ivor-Lewis group was significantly higher than that in the Sweet group(χ²=5.59, P<0.05). After surgery of 1 year, 3 years, 5 years, the rate of lymph node local recurrence and the total rate of tumor metastasis or recurrence in the Ivor-Lewis group were significantly lower than in the Sweet group (P<0.05). The survival rate in the Ivor-Lewis group was significantly greater than that in the Sweet group (P<0.05). Conclusion The cervicothoracic junction has a higher incidence of lymphatic metastasis, which transfer intensity is greater than that of upper abdomen. The extended cervicothoracic lymph node dissection should be indeed indispensible to increase of radical resection and the accuracy of PTNM stage and to improve the long term survival for middle esophageal carcinoma.

Citation： MAOZhi-ming, GUXiao-hua, LIChang-yan, ZHUDong-bing, HUANGHai-sheng, MAOWang-shan, ZHANGTao, SUNJian, ZHAOYang. Metastasis Feature and Dissecting Value of Cervicothoracic Lymph Node for Middle Esophageal Squamous Carcinoma: A Prospective Cohort Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1031-1035. doi: 10.7507/1007-4848.20150256 Copy

1.	Akiyama H,Tsurumaru M,Udagawa H,et al.Radical lymph node dissection for cancer of esophagus.Ann Surg,994,220(3):364-373.
2.	方文涛,茅腾,谷志涛.微创食管癌根治术-优势与风险.中华胸心血管外科杂志,2013,29(7):392-393.
3.	毛友生,赫捷,薛奇,等.全国食管癌规范化诊治推广之路.中华胃肠外科杂志,2013,16(9):801-804.
4.	牛中喜,陈龙奇.NCCN2013食管癌临床实践指南解读.中国胸心血管外科临床杂志,2014,21(1):5-6.
5.	丁建勇,徐松涛.食管癌三野淋巴结清扫术的回顾和展望.中国临床医学,2011,18(6):879-882.
6.	Tachimori Y,Nagai Y,Kanamori N,et al.Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system.Dis Esophagus,2011,24(1):33-38.
7.	Tachibana M,Kinugasa S,Yoshimura H,et al.Extended esophagectomy with 3-field lymph node dissection for esophageal cancer.Arch Surg,2003:138(12):1383-1389.
8.	中国医师协会食管外科专家委员会.微创食管癌切除术(minimally invasive esophagectomy,MIE)专家共识.中华胸心血管外科杂志,2013,29(7):385-387.
9.	于频,主编.系统解剖学.第4版.北京:人民卫生出版.1996.295-296.
10.	柳硕岩,郑庆丰,王枫.胸腔镜腹腔镜下食管癌三野淋巴结清扫术必要性与可行性.中华胸心血管外科杂志,2013,29(7):394-397.
11.	方文涛,陈文虎.食管癌手术治疗原则和淋巴结清扫.中国癌症杂志,2011,(21)7:522-527.
12.	Schwarz RE,Smith DD.Clinical Impact of lymphadenectoy extent in resectable esophageal cancer.J Gastrointest Surg,2007,11:1384-1394.
13.	Fujita H,Sueyoshi S,Tanaka T,et al.Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus:comparing the short and long term outcome among the four types of lymphadenectomy.World J Surg,2003,27(5):571-579.
14.	冒志明,刘劲柏,赵凯国,等.经胸颈段食管胃机械吻合术的临床应用(附82例报告).中华胸心血管外科杂志,1996,12(2):89-90.
15.	冒志明,顾晓华,李昌炎,等.Ivor-Lewis经胸颈部机械吻合术治疗中段食管癌的前瞻性研究.中华消化外科杂志,2013,12(10):367-371.
16.	于长海,孙玉鹗.经胸食管胃颈部机械吻合在食管癌手术中的应用.中华胸心血管外科杂志,2000,16(2):114-115.
17.	张晓,郎保平,靳超,等.经胸食管胃颈部机械吻合在食管癌治疗中的应用.河南科技大学学报(医学版),2004,22(2):87-88.
18.	钱卫平,徐林友,吴斌.经右胸食管胃颈部机械吻合32例分析.皖南医学院学报,2010,29(1):62-63.
19.	汪永和,魏祥志,岳庆峰,等.中段食管癌根治术扩大二野清扫淋巴结的临床体会.安徽医学,2013,34(1):31-33.
20.	Kuge K,Murakami G,Mizobuchi S,et al.Submucosal territory of direct lymphatic drainage system to the thoracic duct in the human esophagus.Thorac Cardiovasc Surg,2003,125:1343-1349.
21.	Mizutani M,Murakakami G,Nawata S,et al.Anatomy of right recurrent nerve node:why does early metastasis of esophageal cancer occur in it?Surg Radiol Anat,2006,28(4):333-338.
22.	Liebermann-Meffert D.Anatomical basis for the approach and extent of surgical treatment of esophageal cancer.Dis Esophagus,2001,14(2):81-84.

1. Akiyama H,Tsurumaru M,Udagawa H,et al.Radical lymph node dissection for cancer of esophagus.Ann Surg,994,220(3):364-373.
2. 方文涛,茅腾,谷志涛.微创食管癌根治术-优势与风险.中华胸心血管外科杂志,2013,29(7):392-393.
3. 毛友生,赫捷,薛奇,等.全国食管癌规范化诊治推广之路.中华胃肠外科杂志,2013,16(9):801-804.
4. 牛中喜,陈龙奇.NCCN2013食管癌临床实践指南解读.中国胸心血管外科临床杂志,2014,21(1):5-6.
5. 丁建勇,徐松涛.食管癌三野淋巴结清扫术的回顾和展望.中国临床医学,2011,18(6):879-882.
6. Tachimori Y,Nagai Y,Kanamori N,et al.Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system.Dis Esophagus,2011,24(1):33-38.
7. Tachibana M,Kinugasa S,Yoshimura H,et al.Extended esophagectomy with 3-field lymph node dissection for esophageal cancer.Arch Surg,2003:138(12):1383-1389.
8. 中国医师协会食管外科专家委员会.微创食管癌切除术(minimally invasive esophagectomy,MIE)专家共识.中华胸心血管外科杂志,2013,29(7):385-387.
9. 于频,主编.系统解剖学.第4版.北京:人民卫生出版.1996.295-296.
10. 柳硕岩,郑庆丰,王枫.胸腔镜腹腔镜下食管癌三野淋巴结清扫术必要性与可行性.中华胸心血管外科杂志,2013,29(7):394-397.
11. 方文涛,陈文虎.食管癌手术治疗原则和淋巴结清扫.中国癌症杂志,2011,(21)7:522-527.
12. Schwarz RE,Smith DD.Clinical Impact of lymphadenectoy extent in resectable esophageal cancer.J Gastrointest Surg,2007,11:1384-1394.
13. Fujita H,Sueyoshi S,Tanaka T,et al.Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus:comparing the short and long term outcome among the four types of lymphadenectomy.World J Surg,2003,27(5):571-579.
14. 冒志明,刘劲柏,赵凯国,等.经胸颈段食管胃机械吻合术的临床应用(附82例报告).中华胸心血管外科杂志,1996,12(2):89-90.
15. 冒志明,顾晓华,李昌炎,等.Ivor-Lewis经胸颈部机械吻合术治疗中段食管癌的前瞻性研究.中华消化外科杂志,2013,12(10):367-371.
16. 于长海,孙玉鹗.经胸食管胃颈部机械吻合在食管癌手术中的应用.中华胸心血管外科杂志,2000,16(2):114-115.
17. 张晓,郎保平,靳超,等.经胸食管胃颈部机械吻合在食管癌治疗中的应用.河南科技大学学报(医学版),2004,22(2):87-88.
18. 钱卫平,徐林友,吴斌.经右胸食管胃颈部机械吻合32例分析.皖南医学院学报,2010,29(1):62-63.
19. 汪永和,魏祥志,岳庆峰,等.中段食管癌根治术扩大二野清扫淋巴结的临床体会.安徽医学,2013,34(1):31-33.
20. Kuge K,Murakami G,Mizobuchi S,et al.Submucosal territory of direct lymphatic drainage system to the thoracic duct in the human esophagus.Thorac Cardiovasc Surg,2003,125:1343-1349.
21. Mizutani M,Murakakami G,Nawata S,et al.Anatomy of right recurrent nerve node:why does early metastasis of esophageal cancer occur in it?Surg Radiol Anat,2006,28(4):333-338.
22. Liebermann-Meffert D.Anatomical basis for the approach and extent of surgical treatment of esophageal cancer.Dis Esophagus,2001,14(2):81-84.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Metastasis Feature and Dissecting Value of Cervicothoracic Lymph Node for Middle Esophageal Squamous Carcinoma: A Prospective Cohort Study

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