Download PDF
Zentralbl Chir 2001; 126(10): 756-762
DOI: 10.1055/s-2001-18253
Originalarbeiten und Übersichten

J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG

Wie radikal soll das Ösophagus- bzw. Kardiakarzinom operiert werden?[*]

What Kind of Surgical Radicality is Justified in the Treatment of Esophageal and Esophago-gastric Junction Tumours?A. Vörös1 , Á. Altorjay1 , P. Nagy2 , T. Jakkel1 , Á. Bohák3 , I. Szántó1 , E. M. Gamal1 , J. Kiss1
  • 1Department of Surgery, Semmelweis University, Faculty of Health Sciences, Budapest, Hungary
  • 2Department of Pathology, Semmelweis University, Faculty of Health Sciences, Budapest, Hungary
  • 3Department of Radiology, Semmelweis University, Faculty of Health Sciences, Budapest, Hungary
Further Information

Publication History

Publication Date:
06 November 2001 (online)

Also available at
    Permissions and Reprints

Summary

In the period from January 1, 1973 to November 30, 1994, a total number of 1 856 patients had been admitted to our Department of Surgery because of cancer of the esophagus and esophago-gastric junction. We divided our activities into two study periods. In the first study period from 1973 to 1984 only so called “conventional operations” were performed. Since 1985 new oncological aspects were introduced into our operative tactics:
1. the subtotal esophagectomy combined with the two-field lymphadenectomy,
2. the total gastrectomy with extended lymph node dissection.
The analysis of our results with respect to the survival parameters (TNM staging, histological type, grade of differentiation, gross pathology) showed that the best chances were obtained by curative resection and lymphadenectomy in tumours of low-grade biologic malignancy. In esophageal cancers the former 6 % 5-year cumulative survival rate increased to 26 %, and in cardia tumours from 9 to 27 %, because of enhancement of radicality and extension of lymphadenectomy.

Zusammenfassung

Zwischen dem 1. Januar 1973 und 30. November 1994 wurden insgesamt 1 856 Patienten wegen eines Ösophagus- bzw. Kardiakarzinoms in unsere chirurgische Abteilung eingewiesen. Wir untersuchten zwei Beobachtungsperioden: in der ersten Zeit (1973-1984) wurden sogenannte „konventionelle Operationen” durchgeführt, seit 1985 haben wir neue onkologische Aspekte bei der operativen Therapie berücksichtigt:
1. Seit dieser Zeit wurde die subtotale Ösophagektomie mit einer Zweifelderlymphadenektomie kombiniert und
2. wurde bei der Gastrektomie eine ausgedehnte Lymphknotendissektion vorgenommen.
Wir überprüften das Überleben unserer Patienten hinsichtlich der Parameter TNM-Stadium, histologischer Typ, Tumordifferenzierungsgrad und makroskopischer Befund. Es zeigte sich, daß die besten Überlebenschancen bei kurativer Resektion und gleichzeitiger Lymphadenektomie von Tumoren mit niedrigem Malignitätsgrad gegeben waren.
Beim Ösophaguskarzinom stieg die kumulative 5-Jahres-Überlebensrate von 6 auf 26 %, beim Kardiakarzinom von 9 auf 27 % an. Dies beruhte auf einer Zunahme der Radikalität und Ausweitung der Lymphadenektomie.

Key words

Esophagus - Cardia - Tumours - Resection - Lymphadenectomy - Survival rates

Schlüsselwörter

Ösophaguskarzinom - Kardiakarzinom - Resektion - Lymphadenektomie - Überlebensraten

1 Übersetzung: R.T. Grundmann, Melsungen

Literatur

  • 1 Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus.  Ann Surg. 1994;  220 364-373
    Google Scholar
  • 2 Altorjay Á, Kiss J, Vörös A. Significance of a modified decompression method in enhancing the safety of esophagus operations.  Hepato-Gastroenterology. 1996;  43 851-853
    PubMedGoogle Scholar
  • 3 Baba M, Aikou T, Natsugoe S, Kusano C, Shimida M, Nakano S, Fukumoto T, Yoshinaka H. Quality of life following esophagectomy with three-field lymphadenectomy for carcinoma, focusing on its relationship to vocal cord palsy.  Dis Esoph. 1998;  11 28-34
    PubMedGoogle Scholar
  • 4 Bumm R, Wong J. Extent of lymphadenectomy in esophagectomy for squamous cell esophageal carcinoma: How much is necessary?.  Dis Esoph. 1994;  7 151-155
    PubMedGoogle Scholar
  • 5 Chen L Q, Hu C Y, Ghadirian P, Duranceau A. Early detection of esophageal squamous cell carcinoma and its effects on therapy: an overview.  Dis Esoph. 1999;  12 161-167
    CrossrefPubMedGoogle Scholar
  • 6 Fok M, Wong J. Cancer of the esophagus and gastric cardia.  Ann Chir Gynec. 1995;  84 179-183
    PubMedGoogle Scholar
  • 7 Fujita H, Kakegawa T, Ando N, Kawahara H, Abe O. Lymph node involvment in carcinoma of the esophagus: reevaulation for the grouping of lymph nodes.  J Jpn Surg Soc. 1985;  86 534-543
    PubMedGoogle Scholar
  • 8 Fujita H, Kakegawa T, Yamana H. et al . Lymph node metastasis and recurrence in patients with a carcinoma of the thoracic esophagus who underwent three-field dissection.  World J Surg. 1994;  18 266-272
    CrossrefPubMedGoogle Scholar
  • 9 Fujita H, Kakegawa H, Yamana H, Shima I. Lymph node compartments as guidelines for lymphadenectomy fo esophageal carcinoma.  Dis Esoph. 1994;  7 169-178
    PubMedGoogle Scholar
  • 10 Fujita H, Kakegawa T, Yamana H. et al . Mortality and morbidity rates, postoperative course, qualitiy of life, and prognosis after extended radical lymphadenectomy for esophageal cancer: comparison of three-field lymphadenectomy with two-field lymphadenectomy.  Ann Surg. 1995;  222 654-662
    PubMedGoogle Scholar
  • 11 Fumagalli U. Resective surgery for cancer of the thoracic esophagus. Consensus Conference, VI. World Congress of ISDE.  Dis Esoph. 1996;  9 30-38
    PubMedGoogle Scholar
  • 12 Hermanek P, Wittekind C. News of TNM and its use for classification of gastric cancer.  World J Surg. 1995;  19 491-495
    CrossrefPubMedGoogle Scholar
  • 13 Isono K, Ochiai T, Koide Y. Indications for extended three-field lymphadenectomy for esophageal cancer.  Dis Esoph. 1994;  7 147-150
    PubMedGoogle Scholar
  • 14 Lerut T, De Leyn P, Coosemans W, Van Raemdonck D, Scheys I, LeSaffre E. Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy.  Ann Surg. 1992;  216 583-590
    PubMedGoogle Scholar
  • 15 Moreno González E, Loinaz Segurola C, Gomez Sanz R, Garcia I, Rico Selas P. Pathogenesis, diagnosis and treatment of cardia cancer.  Dis Esoph. 1995;  7 175-187
    PubMedGoogle Scholar
  • 16 Nishihira T, Mori S, Hirayama K. Extended lymph node dissection for thoracic esophageal carcinoma.  Dis Esoph. 1992;  5 79-89
    PubMedGoogle Scholar
  • 17 Peracchia A, Roul A, Bardini R. et al . Cancer of the thoracic esophagus: What is the adequate lymphadenectomy?.  Dig Surg. 1993;  10 141-145
    PubMedGoogle Scholar
  • 18 Peracchia A, Fumagalli U, Segalin A, Bonavina L. Pathogenesis, diagnosis and treatment of cancer of the tubular esophagus.  Dis Esoph. 1995;  7 167-174
    PubMedGoogle Scholar
  • 19 Peracchia A, Fumagalli U, Bona S. et al .Les curage lympatique extensits dans le cancer de I'oesophage thoracique. In: Launois B (Hrsg). Progres en Gastroenterologie. Doin Editeurs 1996; 12: 37-43
    Google Scholar
  • 20 Siewert R, Roder J D. Lymphadenectomy in esophageal cancer surgery.  Dis Esoph. 1992;  5 91-97
    PubMedGoogle Scholar
  • 21 Siewert R, Stein H J. Carcinoma of the gastroesophageal junction - classification, pathology, and extent of resection.  Dis Esoph. 1996;  9 173-182
    PubMedGoogle Scholar
  • 22 Stassen L PS, Bosman F T, Siersema P D, Hop W CJ, Blomjous J GAM, Tilanus H W. Recurrence and survival after resection of adenocarcinoma of the gastric cardia.  Dis Esoph. 2000;  13 32-38
    PubMedGoogle Scholar
  • 23 Torek F. The first succesful case of resection of the thoracic portion of the oesophagus for carcinoma.  Surg Gynec Obstetr. 1913;  16 614
    PubMedGoogle Scholar
  • 24 Torres A J, Sanchez-Pernaute A, Hernando F, Diez Valladares L, Gonzalez Lopez O, Perez Aguirre E, Suarez A, Balibrea J L. Two-field radical lymphadenectomy in the treatment of esophageal carcinoma.  Dis Esoph. 1999;  12 137-143
    PubMedGoogle Scholar
  • 25 Zieren H U, Muller J M, Pichlmaier H. Prospective randomised study of one- or two layer anastomosis following oesophageal resection and cervical oesophagogastrostomy.  Br J Surg. 1993;  80 608-611
    PubMedGoogle Scholar

1 Übersetzung: R.T. Grundmann, Melsungen

Dr. A. Vöro`s ·Postgraduate Medical University 

Department of Surgery

Szabolcs u. 35

Pf. 1 12


1389 Budapest

Hungary

      >