[Improved treatment of thoracic esophageal cancer based on a retrospective study of recurrence following resection].
Recurrence after resection of thoracic esophageal cancer was classified according to site of recurrence into 5 categories; 1) local recurrence, 2) recurrence at the anastomotic site, 3) recurrence in cervical or mediastinal lymph nodes, 4) recurrence in abdominal lymph nodes and 5) distant organ metastasis. Although the combined resection of the trachea or aorta was performed in several cases with local extension, its clinical results were not superior to those from palliative resection. To prevent recurrence at the anastomotic site, we performed either pharyngeal anastomosis with laryngectomy or esophageal anastomosis just below the larynx. However, such anastomosis just below the larynx was liable to cause aspiration pneumonia. To prevent lymph node recurrence in the neck or mediastinum, we performed cervical and mediastinal lymph node dissection. However, lymph node recurrence in the upper mediastinum of the left side was occasionally observed in case receiving this operation, with lymph node recurrence being decreased by postoperative irradiation, though prognosis was not always improved. Anti-cancer agents CDDP and VDS or 5Fu were effective. To prevent abdominal lymph node recurrence, we recommend that abdominal lymph node dissection is necessarily performed as for cardiac cancer. To prevent distant organ metastasis, we recommend anti-cancer therapy following radical lymph node dissection.
Fujita
H
H
First Department of Surgery, Kurume University, School of Medicine, Japan.
Kakegawa
T
T
Yamana
H
H
Shirouzu
G
G
Negoto
Y
Y
Irie
H
H
Shima
I
I
D004938:Esophageal Neoplasms / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000517:prevention & control*; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies