Evaluation Of The Main Operative Approaches Of The Middle And Lower Thoracic Esophageal Squamous Cell Carcinoma

Objective To compare and evaluate the main operative approaches of the middle and lower esophageal carcinoma, in order to provide reference to the choise of operative approach. Methods The clinicopathologic and follow-up data of 1456 patients suffering from throracic esophageal squamous carcinoma who underwent surgery from January 1983 to December 2001 were studied retrospectively. Possible factors were collected in the data of these patients. The factors included sex, age, smoking, drinking, period of disease, the location and the TNM staging of the tumor, the histologic grading of the tumor, lymphatic metastasis, length of tumor, preoperative and postoperative radio-therapy, preoperative and postoperative chemo-therapy, status of residues, postoperative complications, and so on. The monovariate analysis was studied to find the possible factors influencing the prognosis, then the multivariate analysis was used to determine the main prognostic factors. On this base, according to the location of the tumor and the operative approach, 148 cases of the midial thoracic esophageal squamous cell carcinoma were divided into three-field lymphadenectomy group (group A1), 48 cases into left thoracoabdominal cervical approach group (group A2), and 466 cases into left thoracoabdominal upper arcuate-passage approach group(group A3). 319 cases of the lower thoracic esophageal squamous cell carcinoma were divided into left thoracoabdominal upper arcuate-passage approach group(group B1) and 230 cases into left thoracoabdominal lower arcuate-passage approach group(group B2). The differences of the operative time, the postoperative mortality within 30 days ,the postoperative complications, the status of upper and lower residues, the 1-year, 3-year and 5-year survival rate were compared among the groups respectively. Results The monovariate analysis showed that sex, drinking, diet, TNM staging of tumor, lymphatic metastasis, number of metastasic lymphanodes, total numbers of resected lymphanodes, degree of lymphatic metastasis, positive status of lower residues, property of operation, preoperative cadio-therapy inflenced the prognosis;and occording to multivariate analysis, drinking, property of operation and degree of lymphatic metastasis were of prognostic significance. Among groups of the midial thoracic esophageal squamous cell cancer, the operative time of group A1 is longest, then the group A2, the group A3 is shortest. The postoperative complication rate of the group Al is higher than the rest two groups. The differences of the postoperative mortalities within 30 days, the complication rates, the positive stasus of upper residues and lower residues, the 1-year, 3-year and 5-year survival rates were not ofprognostic significance. In the two groups of lower thoracic esophageal squmous cell carcinoma, the operative time of group Bl was longer than that of group B2 slightly(approximately 10 minutes). The postive status of upper residues of group B2 was higher than that of groupBl apparently (8.7% vs 3.7%, p=0.014). However, the differences of the postoperative complication rates, the postive status of bilateral residues, the mortalities within 30 days, the 1-year, 3-year and 5-year survival rates were not of prognosis significance. Conclusion Degree of lymphatic metastasis and property of operation were the most essential prognostic factors of the patients suffering from thoracic squamous cell carcinoma who underwent surgery. As to the patients suffering from middial and lower thoracic squamous cell carcinoma, the differences had no significance whichever operative approach was chosen. Each of the operative approaches has its advantage and disadvantage. It is a important principle that the operative approaches should be chosen on the base of regarding the patient's operative endurance, preoperative cardiac and lung function, tumor location, depth of tumor invasion, the relationship between the primary tumor and the adjacent organs. Whichever operative approach will be chosen, it is a important procedure that the radical surgery and sufficient lymphadenectomy should be done to improve patient's prognosis.