[The value of extensive lymphadenectomy in cancer of the lower esophagus and cardia].
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.
Istituto di Chirurgia Generale e Oncologia Chirurgica Università di Milano, Ospedale Maggiore Policlinico, I.R.C.C.S. Pad. Monteggia, Italia.
A
A
Peracchia
L
L
Bonavina
R
R
Incarbone
B
B
Chella
D000005:Abdomen; D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery; D002299:Cardia / Q000601:surgery*; D002423:Cause of Death; D004396:Coloring Agents; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008171:Lung Diseases / Q000209:etiology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008482:Mediastinum; D009203:Myocardial Infarction / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010179:Pancreas; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000209:etiology; D018805:Sepsis / Q000209:etiology; D013274:Stomach Neoplasms / Q000601:surgery*; D013909:Thorax
D004396:Coloring Agents
Intérêt de la lymphadénectomie étendue dans le cancer du bas oesophage et du cardia.