頚胸境界部食道癌の合理的リンパ節郭清 生物学的悪性度に応じた合理的切除・郭清

Abstract

During the period from 1980 to 1991, sixteen cases of carcinoma involving the cervicothoracic esophagus were resected in our institute. Among these, nine cases died of a recurrence in the superior mediastinal lymph nodes or in the lungs. Suggesting that prophylactic strategies against these two patterns of recurrence should be considered. As an approach to carcinoma in the cervicothoracic esophagus, we designed an exclusive right thoracic approach: a right anterolateral incision through the fourth intercostal space with an upper median sternotomy, namely an “door open method.” By opening the incised anterior chest wall laterally, optimal access to the cervicothoracic esophagus and the lymph nodes along the recurrent laryngeal nerve is obtained. We have become able to identify preoperatively esophageal cancer patients with high malignancy by factors such as the tendency to relapse in distant organs after surgery, and by an examination of the amplification of some oncogenes (namely int-2/hst-1) in endoscopically biopsied specimens. For this kind of patient, limited field surgery, namely transhiatal esophagectomy, is desirable in order to conserve the patient's immunity, which then makes possible an effective adjuvant chemotherapy following surgery.