Clinical research of lymph node metastasis on the middle and lower segment of 108 patients with esophageal squamous cell carcinoma of Mongolian nationality / 中国基层医药

ABSTRACT

Objective To investigate the lymph node metastasis on the middle and lower segment of esopha-geal squamous cell carcinoma ,understand the factors influencing lymph node metastasis ,to further provide the theory evidence for the lymph node dissection on the middle and lower segment of esophageal squamous cell carcinoma patients of Mongolian nationality .Methods A retrospective study was made in 108 Mongolian patients suffered from the middle and lower segment of esophageal squamous cell carcinoma who accepted radical resection of esophageal carcinoma by three incisions of right chest or combined with right thoracic laparoscopic in three incisions .Results A total of 4914 lymph nodes were dissected,with an averaged clean of (45.5 ±6.0)lymph nodes for each case.80.6％of patients(87/108) were found lymph node metastasis .A total of 624 lymph nodes (624/4914,12.7％) existed metastasis.The rates of superior, middle and inferior mediastimum metastasis for middle segment of esophageal squamous cell carcinoma patients of Mongolian nationality were 20.6％,57.4％ and 39.7％,respectively,while the rates of superior ,middle and inferior mediastimum metastasis for lower segment of esophageal squamous cell carcinoma patients of Mongolian nationality were 17.5％,47.5％and 47.5％,respectively.There was no statistically significant difference between the two groups (P >0.05).The rate of lymph node peritoneal metastasis of lower segment of esophageal squamous cell carcinoma patients of Mongolian nationality was higher than that of middle segment of esophageal squamous cell carcinoma patients of Mongolian nationality (62.5％vs.16.2％,χ2 =24.320,P<0.05). The top three lymph node metastasis sites of middle segment of esophageal squamous cell carcinoma were para esophagus ,carina and recurrent laryngeal nerve .The top three lymph node metastasis sites of lower segment of esophageal squamous cell carcinoma were para esophagus ,cardia side and carina .The influence of the depth of tumor invasion,differentiation degree , intravascular cancer embolus and perineural invasion to the rate of lymph node metastasis was statistically significant(χ2 =21.630,7.568,21.066,4.692,all P<0.05).There were no statistically significant differences of the location ,the tumor length or whether had heavy drinking or not to the rate of lymph node metastasis( all P >0.05).Conclusion The rate of lymph node metastasis on both the middle and lower segment of esophageal squamous cell carcinoma is high .The mediastinum lymph nodes needs to be emphatically cleaned . Abdominal lymph nodes cleaning of lower segment of esophageal squamous cell carcinoma can 't be overlooked .Among the Mongolian patients ,the cleaning key of lymph node on the middle segment of esophageal squamous cell carcinoma are para esophagus ,carina and recurrent laryngeal nerve ,while the cleaning key of lymph node on the middle segment of esophageal squamous cell carcinoma are para esophagus ,cardia side and carina.The deeper the tumor infiltration is,the lower the differentiation degree is , with cancer embolus in vessels , nerve invasion , the higher rate of the lymphatic metastasis.