| Objective: Esophageal cancer is one of the most common malignant tumor diseases,and 90% of esophageal cancer is squamous cell carcinoma with poor prognosis.As the main treatment of patients with esophageal cancer surgery,treatment of chest in esophageal cancer clinical advantage is clear,but because of its special esophageal anatomical structure,its submucosal have rich lymphatic network,high risk of lymph node metastasis,and even have a study of the body,points out that esophageal cancer lymph node metastasis rate is as high as 70%,the area with to neck,upper mediastinal lymph node metastasis.Even in patients with resectable esophageal squamous cell carcinoma,preoperative cervical lymph node metastasis is extremely common,and the lymphocyte metastasis rate is closely related to the tumor location and can increase with the tumor location.Therefore,standardized and effective lymph node dissection is particularly important in patients with esophageal squamous cell carcinoma.Sanye lymph node dissection has been started since the 1980 s.Although it has become the standard surgical procedure for esophageal cancer in Japan,its clinical value is still controversial in Europe,America,China and other Asian countries.In view of this,is by comparing the mino lymph node cleaning technique and two wild lymph nodes were performed in the breast in the lymph node in patients with esophageal squamous cell carcinomas and transfer situation,the influence of the postoperative complications and follow-up survival situation,and combined with multi-factors Cox regression analysis model clearly different lymph nodes were performed in the breast in the prognosis of patients with esophageal squamous cell carcinomas,the influence of the lymph node to different advantage maximization,risk minimization,for specification of esophageal squamous carcinoma in lymph node cleaning scope,improve the breast on the accuracy of the radical segment esophageal surgery and pathological staging provide clinical reference opinions,so as to effectively guide the next treatment,Maximize survival benefits for patients.Methods:The study was conducted retrospectively.The subjects of this study were patients with middle and upper thoracic esophageal squamous cell carcinoma who received three-field lymph node dissection and two-field lymph node dissection in the same treatment group of thoracic surgery department of sichuan cancer hospital from January 2011 to June 2014.According to the inclusion and exclusion criteria,254 cases of middle and upper thoracic esophageal squamous cell carcinoma were finally included in the group and divided into two groups,of which 108 patients who underwent three-field lymph node dissection were included in the three-field group,and 146 patients who underwent two-field lymph node dissection were included in the two-field group.Relevant clinical data of patients were collected and statistically analyzed,including the number of lymph node dissection,lymph node metastasis,length of hospitalization,duration of surgery,postoperative complications: recurrent laryngeal nerve paralysis,pulmonary infection,anastomotic leakage,arrhythmia,perioperative death,and postoperative survival at 1 year and 3 years.Independent factors affecting the prognosis of patients with esophageal squamous cell carcinoma were analyzed by COX regression analysis.Results:In terms of lymph node dissection,4,221 lymph nodes were dissected in three-field group,39.1 lymph nodes were dissected in each patient on average,and 467 lymph node metastases were confirmed by postoperative pathology,with a degree of metastasis of 11.1%(467/4221)?A total of 3156 lymph nodes were dissected in the two-field group,with an average of 21.6 lymph nodes dissected in each patient.The number of metastatic lymph nodes was 234,and the degree of metastasis was 7.4%(234/3156)?Compared with the two groups,the mean number of dissected lymph nodes and the degree of lymph node metastasis in the three-field group were significantly higher than those in the two-field group,and the difference between the two groups was statistically significant(P<0.005)?There were a total of 92 patients with lymph node metastasis in the three-field group,with a metastasis rate of 85.2%(92/108),in which the upper mediastinal lymph node metastasis rate was 65.7%,.There were 78 cases of lymph node metastasis in the two-field group,with a metastasis rate of 53.4%(78/146),and the upper mediastinal lymph node metastasis rate of 34.2%.The total lymph node metastasis rate and the upper mediastinal lymph node metastasis rate in the three field group were significantly higher than those in the two field groups,and the difference between the two groups was statistically significant(?2=28.292,P<0.05;?2=24.685,P<0.05)?There were 54 cases of cervical lymph node metastasis in the three-field group,with a metastasis rate of 50%.The main difference of lymph node metastasis between the two groups was neck and upper mediastinal lymph node metastasis.In terms of postoperative complications,a total of 44 patients in the three-field group had complications within 30 days after surgery,with an incidence of 40.7%(44/108),among which the recurrent laryngeal nerve injury was 28.7%,anastomotic leakage was 13.8%,pulmonary infection and arrhythmia were 22.2% and 9.3% respectively,and no postoperative death cases were found.A total of 51 patients in the field group had complications within 30 days after surgery,with an incidence of 34.9%(51/146),including 14.4% of recurrent laryngeal nerve injury,13.0% of anastomotic leakage,21.2% of pulmonary infection and 8.9% of arrhythmia.One patient died within 30 days after surgery.There was no significant difference in the incidence of postoperative complications,anastomotic leakage,pulmonary infection,arrhythmia and perioperative death between the two groups(P>0.05).However,the incidence of recurrent laryngeal nerve injury was significantly higher in the three-field group than the two-field group,and the difference between the two groups was statistically significant(P<0.05).The main difference in complications between the two groups was the higher incidence of recurrent laryngeal nerve injury in the three-field group.Postoperative follow-up showed that the mean survival time and 1-year and 3-year survival rates in the three-field group were(48.271±1.485)months,92.6% and 56.5%,respectively,which were significantly higher than those in the two-field group(44.742±1.081)months,84.2% and 43.2%(all P<0.05).The three-field lymph node dissection allowed the patients with middle and upper thoracic esophageal squamous cell carcinoma to obtain a longer postoperative survival.Conclusion: Compared with two-field lymph node dissection,three-field lymph node dissection in patients with thoracic middle and upper esophageal squamous cell carcinoma may increase the incidence of some complications,but it does not have a significant negative impact on the survival period.It is important to note that the three-field lymph node dissection allows for more information about the number of lymph nodes and lymph node metastasis.In particular,cervical and upper mediastinal lymph nodes were dissected more thoroughly to improve the accuracy of radical surgery and pathological staging,effectively guide the next step of treatment,reduce postoperative local recurrence and metastasis,improve the postoperative survival of patients. |
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