The Relationship Between The Depth Of Invasion Of Thoracic Esophageal Carcinoma And Regional Lymph Node Metastasis

Esophageal carcinoma is a serious disease to threaten the health of mankind in the world.300-thousands cases or so succumb to this disease every year,and the incidence of esophageal cancer is high in our country,the morbidity and mortality of which is in the first place in some places in our country.Surgical intervention in esophageal carcinoma has a one-hundred years history. In the past half century,esophagus surgery has gained a great advancement,Various kinds combined therapies that developd or developing,but combined therapies are still at clinical trial stage,have no great cooperation is still the primary therapeutic methord.the purpose of Lymphadenectomy is to extend the survival rate,and cut the tumor completely at the same time.the tumor cell can spread to the neck,the thoracic mediastinum and abdominal lymph node, The scope of lymph node dissection is under discussion until now. Status of lymph node metastasis in patients is closely related to tumor stage, surgical way to cure, and the prognosis .To improve awareness of thoracic lymph node metastasis in esophageal cancer will help the surgeon select the appropriate scope of lymphadenectomy.so we study the relationship of thoracic esophageal carcinoma between the depth of invasion and regional lymph node metastasis. a retrospect review of 160 patients (137 males and 23 females,aging from 36 to 78,averaging about 61±4.3 years old,Mongolian 58 cases,102 cases of Han)who underwent esophagectomy for esophageal cancer between June 2005 and July 2008 was conduct to define the relationship between the depth of invasion and regional lymph node metastasis,According to the TNM classification defined by the UICC ,esophagus is divided into upper-,mid- and lower thoracic esophagus;we divided the patients into 3 groups according to the position of the tumor ,the length of the thoracic esophageal carcinoma and the depth of invasion.The 160 cases was performed opacification, esophagofiberoscopy before surgery. 150 cases of them was diagnosised to carcinoma ,the incidence of diagnosis is 97.5%,others was confirmed that atypical hyperplasia of mucous membrane or the possibility of canceration .After the surgery ,all confirmed to be cancer. The number of the patients we performed subtotal esophagectomy weth antero-lateral right thoracotomy,laparotomy and Cervical Esophagogastrostomy is nine..the number of the patients we performed subtotal esophagectomy via a left thoracotomy, with Stapled Esophago-gastrostomy at the Thoracic Apex is 53 ,others are down the aortic arch.For thoracic esophageal cancer, we usually performed a 2-field lymphadenectomy with the mediastinum and abdominal lymphaden scavenged. The lymph node of thorax contains latero- esophago, latero-trachea, aortic window,infer-prominentia,latero-brochus,latero-inferior,pulmonary veins and superior lymph node. Abdominal lymph nodes,including peri-cardia,lesser curvature,greater curvature,left gastric artery and peri-celiac trunk lymph nodes. each multiplecomparison of rate were analyzed by x2 test .We consider results significant when P<0.05.The mid-and lower-thoracic carcinoma cell can spread to both of the thoracic mediastinum and abdominal lymph node,the rate of lymph node metastasis in abdominal cavity in mid-thoracic esophageal carcinoma is 38.9%.the rate of lymph node metastasis in thoracic mediastinum in lower- thoracic esophageal carcinoma is 52.4%; Thoracic lymph node metastasis rate of the Paragraph chest tumor and the Lower thoracic tumor is higher than the Upper thoracic tumor, there is no significant difference between each group.χ2=7.579(P<0.05). The statues of Chest and abdominal lymph node metastasis is Closely related to tumor location,When the Paragraph chest tumor is compared with the Lower thoracic tumor. there is no significant difference between each group. (Chestχ2=0.651(P>0.05)abdominalχ2=3.5778(P>0.05)Statistical correlation was found between postoperative T-staging and LMR,the rate of lympha node metastasis in the stageTis+T1,T2,T3,T4 which was defined according to TNM is 14.3%,40%,62.3%,66.7%(P<0.05);Lymph node metastasis rate of group TisT1,T2 is lower than That of group T3,T4,and there is significant difference between them.χ2=16.718 (P<0.005). Lymph node metastasis rate of T3 is slightly lower than that of T4, there is significant difference between them.χ2=0.31887 (P>0.05).the rate of lymph node metastasis in >5cm and≤5cm esophageal is 65.1%,52.1%, There was no statistical correlation between the length of lesion and regional LMR (P>0.05) and between the site of thoracic esophageal carcinoma and"jumping"regional lymph node metastasis。The facts which influence the metastasis of lymph node are the depth of the tumor invades and the position of the tumor,but not the length of the tumor.LMR of thoracic esophageal carcinoma showed bidirec tional metastasis, different regional LMR of mediastinum correlated to the site of lesion and postoperative T-staging,but not to the length of the tumor.The regional mediastinal lymph node draining thoracic esophageal carcinoma should be dissected strictly.