초록접수 현황
| 15F-075 | 구연 발표 |
The Extent of Mediastinal Lymphadenectomy Affects Postoperative Survival in Patients with Superficial Esophageal Squamous Cell Carcinoma
김대준, 정희석, 도영우, 남경식, 이창영, 이진구, 백효채, 정경영
연세대학교 의과대학 세브란스병원 흉부외과학교실
Background : The rate of lymph node metastasis varies in superficial esophageal squamous cell carcinoma (ESCC), and some controversies have been remained in need for aggressive mediastinal lymphadenectomy (ML) in this subset of patients.
Methods : Of 270 patients who underwent esophagectomy from July 2006 to December 2014, 129 patients with superficial ESCC were enrolled in this study. Aggressive ML including recurrent laryngeal nerve (RLN) nodes was performed in 87 patients (group 1), and traditional 2-field or transhiatal esophagectomy was performed in 42 patients (group 2).
Results : There were no differences in age, sex, and a distribution of clinical stages between two groups. R0 resection was achieved in all patients, and the number of dissected nodes was 45.6 ± 1.9 in group 1 and 28.0 ± 1.8 in group 2, respectively (p=0.041). Rate of RLN palsy was lower in group 2 (16.7% vs 32.2%, p=0.063), and two operative mortality were observed in group 1. In terms of pathological data, there were no differences in pT stage, tumor length, differentiation, and lymphovascular permeation. Lymph node metastasis was found more commonly in group 1 (28 patients, 32.9%) than in group 2 (7 patients, 16.7%) (p=0.018). During follow-up, 5 patients (5.9%) in group 1 and 14 patients (33.3%) in group 2 died (p=0.000). In group 2, overall recurrence rate (28.6% vs 3.5%, p=0.000) and loco-regional recurrence rate (19.0% vs 0.0%, p=0.000) were higher than those in group 1. There was a significant difference in the 5-year overall survival (88.1% in group 1 vs 72.3% in group 2, p=0.043) as well as the 5-year recur-free survival (95.0% in group 1 vs 69.4% in group 2, p=0.002).
Conclusion : Our data suggests that aggressive ML should be recommended even in superficial ESCC because it could provide a lower incidence of recurrence and a better survival.
Methods : Of 270 patients who underwent esophagectomy from July 2006 to December 2014, 129 patients with superficial ESCC were enrolled in this study. Aggressive ML including recurrent laryngeal nerve (RLN) nodes was performed in 87 patients (group 1), and traditional 2-field or transhiatal esophagectomy was performed in 42 patients (group 2).
Results : There were no differences in age, sex, and a distribution of clinical stages between two groups. R0 resection was achieved in all patients, and the number of dissected nodes was 45.6 ± 1.9 in group 1 and 28.0 ± 1.8 in group 2, respectively (p=0.041). Rate of RLN palsy was lower in group 2 (16.7% vs 32.2%, p=0.063), and two operative mortality were observed in group 1. In terms of pathological data, there were no differences in pT stage, tumor length, differentiation, and lymphovascular permeation. Lymph node metastasis was found more commonly in group 1 (28 patients, 32.9%) than in group 2 (7 patients, 16.7%) (p=0.018). During follow-up, 5 patients (5.9%) in group 1 and 14 patients (33.3%) in group 2 died (p=0.000). In group 2, overall recurrence rate (28.6% vs 3.5%, p=0.000) and loco-regional recurrence rate (19.0% vs 0.0%, p=0.000) were higher than those in group 1. There was a significant difference in the 5-year overall survival (88.1% in group 1 vs 72.3% in group 2, p=0.043) as well as the 5-year recur-free survival (95.0% in group 1 vs 69.4% in group 2, p=0.002).
Conclusion : Our data suggests that aggressive ML should be recommended even in superficial ESCC because it could provide a lower incidence of recurrence and a better survival.
책임저자: 김대준
연세대학교 의과대학 세브란스병원 흉부외과학교실
연락처 : 정희석, Tel: 02-2228-2140 , E-mail : haobbang80@gmail.com
