Objective To explore the safety of minimally invasive esophagectomy (MIE) with three-field lymphadenectomy (3-FL) for esophageal squamous cell carcinoma (ESCC) by comparing the short-term outcomes between the 3-FL and the two-field lymphadenectomy (2-FL) in MIE. Methods The clinical data of patients with ESCC who underwent minimally invasive McKeown esophagectomy in our hospital from July 2015 to March 2022 were collected retrospectively. Patients were divided into a 3-FL group and a 2-FL group according to lymph node dissection method. And the clinical outcomes and postoperative complications were compared between the two groups. Results A total of 257 patients with ESCC were included in this study. There were 211 males and 46 females with an average age of 62.2±8.1 years. There were 109 patients in the 3-FL group and 148 patients in the 2-FL group. The operation time of the 3-FL group was about 20 minutes longer than that of the 2-FL group (P<0.001). There was no statistical difference between the two groups in the intraoperatve blood loss (P=0.376). More lymph nodes (P<0.001) and also more positive lymph nodes (P=0.003) were obtained in the 3-FL group than in the 2-FL group, and there was a statistical difference in the pathological N stage between the two groups (P<0.001). But there was no statistical difference in the incidence of anastomotic leak (P=0.667), chyle leak (P=0.421), recurrent laryngeal nerve injury (P=0.081), pulmonary complications (P=0.601), pneumonia (P=0.061), cardiac complications (P=0.383), overall complications (P=0.147) or Clavien-Dindo grading (P=0.152) between the two groups. Conclusion MIE 3-FL can improve the efficiency of lymph node dissection and the accuracy of tumor lymph node staging, but it does not increase the postoperative complications, which is worthy of clinical application.
目的探讨胸中上段食管癌淋巴结清扫的合理范围。 方法回顾性分析2010年1月至2013年10月我院134例胸中上段食管癌淋巴结清扫患者的临床资料。将患者分为两组：三野组，56例，男50例、女6例，年龄（55.4±9.6）岁，行三野淋巴结清扫根治术；二野组，78例，男69例、女9例，年龄（56.3±7.3）岁，行完全二野淋巴结清扫根治术。比较两组临床效果。 结果三野组患者淋巴结转移率明显高于二野组（60.7%vs.42.3%，P < 0.05），主要差别在于三野组有较高的颈部淋巴结转移率（21.4%）。三野组与二野组患者上纵隔淋巴结转移率分别为33.9%和30.8%，差异无统计学意义（P>0.05）。三野组及二野组患者术后并发症发生率差异无统计学意义（P>0.05）。三野组及二野组患者术后１年生存率分别为96.3%和85.5%，差异有统计学意义（P < 0.05）；三野组及二野组患者术后1年内颈部淋巴结复发率分别为1.9%和11.8%，差异有统计学意义（P < 0.05）。 结论三野淋巴结清扫根治术有助于提高胸中上段食管癌手术根治性，能减少术后局部复发和转移，提高患者术后生存率，相对于完全二野淋巴结清扫术并不显著增加手术并发症。