Between 1980 and 1997, 1194 patients with a malignant tumor of the lower esophagus have been observed and treated in our Institution. There were 555 patients (46.5%) presenting with squamous-cell carcinoma, 101 (8.5%), with Barrett's adenocarcinoma and 538 (45%) with cardia adenocarcinoma. Most patient underwent a transthoracic esophagectomy with esophagogastroplasty; transhiatal approach was mainly reserved to high-risk patients. Over the past two years sixty-three patients (42 with adenocarcinoma and 21 with squamous cell carcinoma) underwent enlarged mediastinal lymphadenectomy. Three patients (4.7%) died post-operatively: one sepsis, in pulmonary embolism and one myocardial infarction. Four patients (6.3%) developed pulmonary complications: no patient had recuriential palsy. Pathologic exam revealed 1342 nodes (807 thoracic and 827 abdominal). Twenty patients (31.7%) had mediastinal nodal metastases, of which 8 in the upper mediastinum. Median follow-up was 19 months (2-36 months). Seven of the sixteen patients with recurrent disease (12 systemic, 3 mediastinal and 1 anastomotic) died. The number of metastatic nodes increased with serial section and even more with immunohistochemical staining technique (from 11.7% to 13% to 15.5%, respectively). Two patients were up-staged from M0 to M1 because of peripancreatic nodal micrometastases. We conclude that enlarged mediastinal lymphadenectomy allowed to detect upper mediastinal lymph node metastases in 12.8% of patients without increasing post-operative complication rate. A longer follow-up is required to evaluate the impact on long term survival.
|Titolo:||[The value of extensive lymphadenectomy in cancer of the lower esophagus and cardia]|
BONAVINA, LUIGI (Secondo)
|Parole Chiave:||Pulmonary Embolism; Lymphatic Metastasis; Humans; Esophageal Neoplasms; Pancreas; Cause of Death; Esophagectomy; Stomach Neoplasms; Thorax; Barrett Esophagus; Gastrectomy; Myocardial Infarction; Abdomen; Mediastinum; Coloring Agents; Sepsis; Postoperative Complications; Lung Diseases; Cardia; Follow-Up Studies; Neoplasm Recurrence, Local; Carcinoma, Squamous Cell; Adenocarcinoma; Lymph Node Excision; Immunohistochemistry|
|Settore Scientifico Disciplinare:||Settore MED/18 - Chirurgia Generale|
|Data di pubblicazione:||nov-1997|
|Appare nelle tipologie:||01 - Articolo su periodico|