选择性颈胸腹三野淋巴结清扫治疗胸段食管鳞癌

目的 研究胸段食管鳞癌的淋巴结转移规律，探讨合适的淋巴结清扫范围。方法 87例接受食管次全切除术的胸段食管鳞癌患者，根据术前食管腔内超声和颈部超声检查结果，选择性进行胸腹二野或颈胸腹三野淋巴结清扫。结果 超声发现颈部淋巴结肿大并行三野清扫35例（40．2％，三野清扫组），其中原发肿瘤位于胸上段食管者的比例（16／24例，66．7％）显著高于中、下段肿瘤者（19／63例，30．2％）（P=0．002）。三野清扫术扫除淋巴结13．7组／例，显著多于二野清扫组（52例，59．8％）的10．5组／例（P〈0．001）。术后病理检测三野清扫组转移淋巴结1．5组／例，也显著多于二野清扫组的0．8组／例（P〈0．01）。颈淋巴结转移（pM1-LN）17例（占全组19．5％，占三野清扫组48．6％），有区域淋巴结转移者的颈淋巴结转移比例（15／48例，31．3％）显著高于无区域淋巴结转移者（2／39例，5．1％）（P〈0．01）。上、中、下纵隔及上腹部的淋巴结转移率分别为25．3％、23．O％、5．7％和24．1％，颈淋巴结转移与上纵隔（P〈0．01）及中纵隔（P〈0．01）淋巴结转移显著相关，但与下纵隔及上腹部淋巴结转移无关。三野清扫组术后并发症发生率（60．0％）显著高于二野清扫组（34．6％，P=0．020）。喉返神经损伤发生率两组差异无统计学意义（P〉0．05）；但喉返神经损伤者吻合口瘘发生率（7／13例，53．8％）显著高于无喉返神经损伤者（10／74例，13．5％，P=0．001）。术后死亡率两组差异无统计学意义（P〉0．05）。结论 应对肿瘤位于胸上段食管、或上纵隔及中纵隔淋巴结已发生转移的食管癌患者在超声指导下进行选择性颈胸腹三野淋巴结清扫术，以降低手术风险、提高手术根治效果。     

微创食管切除术联合三野或二野淋巴结清扫术治疗食管鳞状细胞癌257例近期疗效的回顾性队列研究

目的 比较食管鳞状细胞癌（鳞癌）患者接受微创食管切除术（minimally invasive esophagectomy,MIE）联合三野淋巴结清扫术（three-field lymphadenectomy,3-FL）或二野淋巴结清扫术（two-field lymphadenectomy,2-FL）的短期结果,探讨食管癌微创3-FL的安全性。方法 回顾性分析2015年7月—2022年3月于解放军总医院第六医学中心胸外科行MIE(McKeown术式)患者的临床资料。根据淋巴结清扫方式,将患者分为3-FL组和2-FL组,比较两组患者的临床资料和术后并发症。结果 共257例食管鳞癌患者纳入研究,其中男211例、女46例,平均年龄（62.2±8.1）岁。3-FL组109例,2-FL组148例。3-FL组手术时间较2-FL组长约20 min,差异有统计学意义（P<0.001）;两组术中出血量差异无统计学意义（P=0.376）。3-FL组比2-FL组清扫淋巴结个数更多（P<0.001）以及获得阳性淋巴结数更多（P=0.003）,且两组病理N分期差异有统计学意义（P<0.001）。...     

食管微创解剖特点在食管癌三野清扫中的应用

目的 探讨食管及其周围结构的微创解剖特点在胸腹腔镜下食管癌三野淋巴结清扫术中的应用.方法 回顾性分析2011年7月至2012年9月间汕头市中心医院收治的67例食管癌患者的临床资料,所有病例均行三野淋巴结清扫术,根据食管系膜的微创解剖学特点选择恰当的操作平面;胸腔镜下以奇静脉为界,将操作空间分为上、下食管三角;胰腺是腹腔镜下胃游离的关键解剖标志,胰周间隙是腹腔镜手术和天然外科平面;椎前筋膜是颈部清扫的底面,两侧则以颈动脉鞘为界.结果 全组手术时间220～320（平均251.6）min,术中出血量为40～320（平均105.6）ml.共清扫淋巴结1949枚,每例13～46（平均 29.1）枚,其中胸区淋巴结平均15.1枚/例,腹区8.2枚/例,颈区5.8枚/例.无围手术期死亡病例.术后随访2～14（平均8.2）月,随访率 98.5％（66/67）,受访患者均存活,出现反流性食管炎10例,吻合口狭窄3例.结论 建立腔镜下整体解剖观念、明确食管系膜的解剖层面和镜下定位,有助于提高腔镜食管癌根治术的安全性和根治性.     

食管癌三野清扫根治术后腋窝淋巴结转移1例

病人　男 ,5 3岁。 2 0 0 2年 7月在全麻下行食管中段癌三野清扫术。术后病理报告 :食管 (中段 )中分化鳞癌 ,大小 4 5cm× 3 0cm ,溃疡型 ,癌组织浸润食管壁全层。上段食管旁淋巴结见癌转移 (2 7个 ) ,颈部淋巴结 (5个 )、胸部气管旁淋巴结(5个 )、隆凸下淋巴结 (4个 )、中段食管旁淋巴结 (3个 )、下段食管旁淋巴结 (2个 )、贲门旁淋巴结 (2个 ) ,胃小弯及胃左淋巴结 (3个 )均未见淋巴结转移。术后病人恢复良好 ,未行辅助化疗 ,出院后进食正常 ,活动自如。同年 12月病人自觉左腋窝异样感 ,触摸时发现包块 ,无疼痛 ,入院诊治。查体 :双侧…     

食管癌三野淋巴结清扫术后乳糜腹1例

病例:男,63岁。因进食梗阻4个月、食管活检示中胸段食管鳞状细胞癌而收入院。入院后在全麻下行食管癌三野淋巴结清扫根治、胃代食管左颈吻合手术,术中常规清扫颈、全胸及腹腔淋巴结,膈上常规结扎胸导管。术毕置胸腔引流管2根和腹腔引流管1根于膈裂孔下、胰腺上方。术后腹腔引流量较多,前3天平均>500ml/d,此后逐渐减少至50ml/d。术后第8天进食后腹腔引流量明显增多,>800ml/d,呈乳黄色或肉粉色,混浊,静置后分层明显,苏丹Ⅲ染色阳性,确诊为乳糜腹。予禁食、全肠外营养等保守治疗,但腹腔引流液持续>600ml/d。于术后第32天再行剖腹探查术,术前30m…     

胸段食管鳞癌淋巴结转移规律探究

目的探讨胸段食管鳞癌淋巴结转移规律及其影响因素,以指导淋巴结清扫方式。方法回顾分析漳州市医院2010年4月至2012年7月手术治疗的328例胸段食管鳞癌的临床病理资料,探讨淋巴结转移规律及其影响因素。结果全组328例共清扫淋巴结9937枚,平均30．3枚／例。共437枚、153例有淋巴结转移,转移率46．65％;其中喉返神经旁淋巴结转移18．30％,10．46％喉返神经旁淋巴结为唯一转移部位。胸段食管癌淋巴结转移与肿瘤部位、长度、分化程度及浸润深度明显相关。胸上段食管癌淋巴结转移方向主要向上纵隔及下颈部;胸中段食管癌颈、胸、腹均可发生淋巴结转移;胸下段食管癌主要向腹腔、中下纵隔转移。结论食管上段鳞癌,颈部淋巴结转移率高,应行三野淋巴结清扫;下段食管癌清扫重点在腹腔、中下纵隔;中段鳞癌应提倡进行个体化清扫和适度清扫;分化程度差,浸润程度深的病例应适当扩大清扫范围。胸段食管癌喉返神经旁淋巴结转移率高,均应行喉返神经旁淋巴结清扫。     

胸段食管癌三野淋巴清扫的现状

食管癌的淋巴清扫范围多年来缺乏规范性意见。1994年第五届国际食管疾病会议始对其统一命名并做相关规定。据其清扫范围逐步扩大分4类：标准淋巴清扫（标准清扫），扩大淋巴清扫（扩大清扫），全淋巴清扫（全清扫），三野淋巴清扫（三野清扫）。标准清扫即下纵隔、上腹部淋巴清扫，扩大清扫在前者基础上增加右上纵隔淋巴清扫，全清扫在扩大清扫基础上增加左上纵隔淋巴清扫，三野清扫在全清扫基础上增加双侧颈部淋巴清扫。为获更好的外科疗效及术后准确分期，三野清扫已在日本等国的大型医疗机构提倡实施。     

食管癌淋巴结清扫数目与术后并发症的关系

目的探讨食管癌手术中淋巴结清扫枚数及组数与术后并发症的关系。方法回顾性总结2008年1月至2009年12月间四川大学华西医院收治的794例行食管癌根治性手术患者的临床病理资料．分析食管癌术后并发症的危险因素。结果全组无手术死亡病例,有84例（10．6％）患者出现术后并发症。全组共清扫11770枚淋巴结,平均每例14．8枚。多因素逻辑回归分析显示．患者性别、淋巴结转移数目、吻合部位与手术医生技能水平是食管癌术后并发症的影响因素（均P〈0．05）,而淋巴结清扫枚数及组数对于术后并发症发生率并无显著影响（均P〉0．05）。结论食管癌术后并发症的发生率与一定范围内淋巴结清扫数（小于50枚）及组数的增加无关,应尺可能广沔讹涪相含咎陌协滋田结     

胸段食管癌淋巴结转移特点的临床研究

目的 探讨胸段食管癌淋巴结转移的规律和特点,从而为其手术入路和淋巴结清扫范围提供参考.方法 回顾性分析2009年1月至2012年12月间中南大学湘雅医学院附属肿瘤医院胸外科收治的72例胸段食管癌患者的临床资料,所有病例均行右胸入路手术. 记录各组淋巴结的清扫及转移情况,并分析淋巴结转移的影响因素.结果 72例患者中,有48例出现淋巴结转移,淋巴结转移率为66.7％;清扫淋巴结总数为1495枚,转移181枚,淋巴结转移度为12.1％,平均每例清扫淋巴结20.8枚.在各组淋巴结中,右喉返神经旁（1R组）淋巴结转移率最高,达30.6％（22/72）.左喉返神经旁淋巴结（2L组、4L组和5组） 转移率为12.5％（9/72）.淋巴结转移率与肿瘤大小和浸润深度有关（均P＜0.05）,而与病变部位和分化程度无关（P＞0.05）.结论 胸段食管癌淋巴结转移以右喉返神经旁淋巴结转移为主,故其手术最佳入路应是右胸入路,淋巴结清扫则应以右、左喉返神经旁淋巴结为重点的系统纵隔、腹野淋巴结清扫.     

胸段食管癌淋巴结转移规律及其对淋巴结清扫方式的影响

目的探讨胸段食管癌淋巴结转移规律及其对淋巴结清扫方式的影响。方法对接受三野淋巴结清扫的230例食管鳞癌病人的肿瘤部位、临床病理指标与淋巴结转移的关系进行分析。结果每例病人的淋巴结切除11～71枚，平均（25．3±11．4）枚。其中133例病人存在区域淋巴结转移。颈、胸和腹三区淋巴结转移率，上胸段食管癌为41．6％、19．44％和8．3％，中胸段食管癌为33．3％、34．7％和14％，下胸段食管癌为36．4％、34．1％和43．2％。上、中、下胸段食管癌颈部或胸腔淋巴结转移率差异无统计学意义，下胸段食管癌腹腔淋巴结转移率显著高于上胸段或中胸段食管癌。Logistic回归模型显示肿瘤浸润深度和淋巴管血管浸润情况是影响淋巴结转移的有意义因素。结论对各胸段食管癌均应清扫颈、胸部淋巴结，上、中胸段食管癌腹部淋巴结清扫的意义尚需进一步研究。病人的肿瘤浸润深度及有无淋巴血管浸润与淋巴结是否转移密切相关。     

Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma

OBJECTIVE: Opinions are conflicting about 3-field lymph node dissection (3FLND) during esophagectomy for esophageal cancer. In the current study, we sought to determine the prevalence of cervical and upper thoracic lymph node metastasis in patients with squamous cell carcinoma of the thoracic esophagus and to determine the impact of 3FLND on mortality, morbidity, survival, and recurrence rate. MATERIALS AND METHODS: Among 287 patients with squamous cell carcinoma of the thoracic esophagus seen between November 1985 and December 2001, 141 (49%) underwent extended esophagectomy with 3FLND (cervical, mediastinal, and abdominal lymph node dissection). Patients were observed and clinicopathologic information collected prospectively on all patients until death or August 2002. The median follow-up was 41 months, ranging from 10 to 173 months. RESULTS: Hospital mortality and morbidity rates were 6.4% and 80%, respectively. Thirty-four of 70 node-positive patients had cervicothoracic nodal involvement. Sixteen patients (11%) had nodal involvement confined only to the cervicothoracic nodes, and no patients with lower thoracic esophageal carcinoma showed cervicothoracic involvement alone. The frequency of cervical nodal disease was correlated with nodal status within the mediastinum (P <0.01). The 1-, 3-, and 5-year overall survival rates for all 141 patients were 76%, 58%, and 48%, respectively. Among significant variables verified by univariate analysis, independent prognostic factors for overall survival determined by multivariate analysis were number of lymph node metastasis (P <0.01), amount of blood transfusion (P <0.05), length of operation (P <0.05), and presence of pulmonary complications (P <0.05). CONCLUSIONS: Extended esophagectomy with 3FLND can be performed with an acceptable mortality. Metastases frequently involved the upper thoracic and cervical lesions, and cervical nodal disease was correlated with thoracic nodal status. 3FLND proved to be an important staging system in 11% of patients. An excellent overall survival suggests a superiority of 3FLND when performed at experienced centers.     

The pattern and prevalence of lymphatic spread in thoracic oesophageal squamous cell carcinoma

Background: Oesophageal squamous cell carcinoma (SCC) is a common type of cancer in China. The knowledge of its pattern of lymphatic metastasis would be of clinical value for surgical and radiation oncologists to treat this disease. Material and methods: A large series of 1850 thoracic oesophageal SCC was retrospectively analysed after extended oesophagectomy with three-field lymphadenectomy (3FL). Specimens were assessed for pattern of lymphatic spread. Result: Of the 1850 patients, 1081 (58.4%) developed mediastinal, cervical and/or abdominal node metastases. The lymphatic metastasis rates were 35.6%, 22.2%, 26.5%, 6.1% and 26.5%, respectively, for the cervical, upper, middle, lower mediastinal nodes and abdominal nodes. The adjacent mediastinal node metastasis alone occurred in 5.5% of patients, and the multiple level or skip node spread accounted for 20.9% and 73.6% of patients with node metastases. Upward lymphatic spread developed in 46.4% of patients, both up- and downward in 33.2%, and the downward, 20.5%. For the upper oesophageal SCC, the most common node metastasis was in the cervical (49.5%) and followed by the upper mediastinal (28.7%), middle mediastinal (11.4%), abdominal (8.0%) and lower mediastinal (1.4%) nodes. For the middle oesophageal SCC, the highest incidence of node spread was also in the cervical (35.0%) and similar rates in the middle mediastinal (29.8%), abdominal (27.2%) and upper mediastinal (22.4%) nodes, but the least in the lower mediastinal (6.0%) node. For the lower oesophageal SCC, more node metastasis occurred in the abdominal (51.7%), and followed by the middle mediastinal (25.6%), cervical (17.2%), lower mediastinal (13.9%) and upper mediastinal (10.0%). However, the lymphatic metastasis rates of the upper, middle and lower thoracic oesophageal SCC were similar. The unfavourable factors for lymphatic metastasis were long oesophageal lesion (p < 0.000), late T stage (p < 0.000) and poor differentiation of tumour cells (p < 0.000). Conclusion: The prevalence was: (1) lymphatic spread prone to the upward in the upper oesophageal SCC, downward in the lower one and both up- and downward in the middle one with in favour of the upward and (2) multiple level and skip node metastases were very often seen. The unfavourable factors for node spread were long oesophageal lesion, late T stage and poor differentiation of tumour cells.     

T2胸中段食管鳞癌淋巴结转移特点和规律

目的 探讨T2胸中段食管鳞癌淋巴结转移特点和规律.方法 分析246例接受颈、胸、腹三野淋巴结清扫的T2胸中段食管鳞癌病人的临床病理指标与淋巴结转移的关系.结果 每例病人清扫淋巴结15～59枚,平均25枚.其中129例存在区域淋巴结转移.颈、胸和腹三区淋巴结转移率分别为28.9%、28.5%和22.0%,差异无统计学意义.Logistic回归模型显示肿瘤长度、肿瘤细胞分化程度及有无淋巴管血管浸润是影响淋巴结转移的有意义因素.结论 T2胸中段食管鳞癌淋巴结转移与肿瘤长度、肿瘤细胞分化程度及有无淋巴管血管浸润明显相关;T2胸中段食管鳞癌有上、下双向转移和跳跃性转移的特点,应行三野淋巴结清扫,对胸中段超出T2的食管鳞癌也应行以上手术.

Abstract：

Objective To investigate the pattern of lymph node metastasis in patients with 17 and middle thoracic esophageal squamous cell carcinoma( ESCC). Methods Retrospective review the clinical data of 246 cases with T2 and middle thoracic esophageal squamous cell carcinoma who were treated by three-field lymphadenectomy. Analyze the relationship between clinical pathological factors and lymph node metastasis. Results Lymph node metastases were found in 129 of the 246 patients (52.4% ).The average number of resected lymph nodes was 25 per patient (rangel5 -59). The rates of lymph node metastasis were 28.9% in the neck, 28.5% in thoracic mediastinum and 22.0% in abdominal cavity for patients with T2 and middle thoracic ESCC. No significant difference in lymph node metastasis' rate was observed among the neck, thoracic mediastinum and abdominal cavity. Logistic-regression showed the length of tumor, tumor cell differentiation and angiolymphatic invasion were factors influencing lymph node metastasis. Conclusion Lymph node metastasis in T2 and middle thoracic ESCC has the characteristics of upward, downward and skip spreading. Patients with T2 and middle thoracic ESCC should be treated with radical surgery with three-field lymphadenectomy.     

影响胸段食管鳞癌切除术预后的因素

目的探讨影响胸段食管癌患者切除手术的预后因素。方法对217例经颈、胸、腹“3区域”淋巴结清除根治术患者,选择对食管癌切除术预后可能产生影响的9个特征性临床病理因素进行回顾性预后分析。结果全组淋巴结清除术后1、3、5年生存率分别为82.6%、59.8%、和48.8%。影响预后的单因素分析表明肿瘤浸润深度、分化程度、临床分期、淋巴结转移个数、淋巴结转移区域数和年龄对预后有影响。影响预后的Cox模型多因素分析表明,肿瘤浸润深度、分化程度、淋巴结转移区域数和肿瘤部位对预后有显著的影响。随着食管癌淋巴结转移区域数的增加,患者生存率逐渐下降(P=0.0284)。结论淋巴结转移尤其是淋巴结转移区域数是胸段食管癌切除术后影响患者预后的主要因素;因此,胸段食管癌尤其是胸上、中段食管癌在条件具备时应施行“3区域”淋巴结清扫术。     

Lymphatic spreading and lymphadenectomy for esophageal carcinoma

Esophageal carcinoma(EC) is a highly lethal malignancywith a poor prognosis. One of the most important prognostic factors in EC is lymph node status. Therefore, lymphadenectomy has been recognized as a key that influences the outcome of surgical treatment for EC. However, the lymphatic drainage system of the esophagus, including an abundant lymph-capillary network in the lamina propria and muscularis mucosa, is very complex with cervical, mediastinal and celiac node spreading. The extent of lymphadenectomy for EC has always been controversial because of the very complex pattern of lymph node spreading. In this article, published literature regarding lymphatic spreading was reviewed and the current lymphadenectomy trends for EC are discussed.     

不同N1状态对胸段食管鳞癌预后的影响

目的探讨不同N1状态对胸段食管鳞癌预后的影响。方法连续收治并行根治性切除胸段食管鳞癌的N1病人341例，以淋巴结转移数、转移度、转移区域数等因子进行单因素和多因素分析，探讨其与预后的关系。结果单因素分析显示，淋巴结转移数1～3个与大于3个、淋巴结转移度≤20％与〉20％、转移的区域数不同、是否有喉返神经旁淋巴结转移，其1、3、5年生存率差异有统计学意义。但多因素分析显示，仅淋巴结转移的个数对预后有显著影响，P=00001。结论淋巴结转移数、转移度、转移的区域多少与胸段食管鳞癌病人预后有关，仅淋巴结转移个数是其独立预后因素，转移数大于3个者预后较差。     

Prognostic significance of the location of intramural metastasis in patients with esophageal squamous cell carcinoma

Background Although the presence of an intramural metastasis (IM) from esophageal cancer is associated with a poor prognosis, some patients with IM have a relatively favorable course.Methods Clinicopathological factors including number, location, and size of IM and the distance between the primary tumor and IM were assessed in 212 patients with esophageal squamous cell carcinoma who underwent esophagectomy.Results Twenty-three patients (10.8%) had IM. IM size ranged from 2 to 100 mm (18±26), and the distance between primary lesion and IM ranged from 5 to 70 mm (27±18). Survival of ten patients with an IM less than 20 mm from the primary tumor was significantly longer than that of 13 patients with a more distant IM (P=0.0184); median survival time were 2.3 and 0.7 years, respectively.Conclusion A subgroup of patients with an IM less than 20 mm from the primary esophageal cancer may have a relatively favorable prognosis. When an IM is found preoperatively or in a resected specimen, measurement of the distance between the primary tumor and the IM might be useful in determination of treatment strategy and evaluation of prognosis.     

Clinicopathologic characteristics and survival of patients with clinical Stage I squamous cell carcinomas of the thoracic esophagus treated with three-field lymph node dissection

Objective: Clinicopathologic characteristics and survival rates of patients with clinical Stage I tumors treated with three-field lymph node dissection have not been well investigated. This report documents the results of a series of cases of clinical Stage I squamous cell carcinomas treated with this surgical procedure in our institute. Methods: From January 1988 to March 1997, 326 patients with carcinomas of the thoracic esophagus underwent transthoracic esophagectomy with three-field lymph node dissection. Two hundred and ninety-seven (91%) of these had squamous cell carcinomas. Fifty-seven (18%) patients with clinical Stage I squamous cell carcinomas of the thoracic esophagus were retrospectively reviewed here. Results: Among 57 clinical Stage I squamous cell carcinomas, ten (18%) were diagnosed as T1-mucosal and 47 (83%) as T1-submucosal. Seventy percent of the patients with clinical T1-mucosal tumors had additional primary esophageal lesions. The operative morbidity and in-hospital mortality rates were 63 and 0%, and the overall 1-, 3-, 5-, and 10-year survival rates were 95, 86, 78, and 70%, respectively. Of the 57 tumors assessed pathologically, 12 (21%) were T1-mucosal, 42 (74%) were T1-submucosal, and three (5%) were T2. Nineteen (33%) exhibited lymph node metastasis. The 1-, 3-, 5-, and 10-year survival rates for patients with lymph node metastasis were 90, 79, 73, and 58%, respectively, as compared with 97, 90, 80, and 76, respectively for patients without lymph node metastasis (P=0.24). The accuracy of preoperative staging, based on both wall penetration and the status regarding lymph node metastasis, was 63%. With reference to the 1997 UICC-TNM staging system, 36 (63%) were pStage I, two (4%) were pStage IIA, 18 (28%) were pStage IIB, and three (6%) were pStage IVB. The 1-, 3-, 5-, and 10-year survival rates for patients with pStage I disease were 97, 92, 85, and 81%, respectively. In those with pStage II or IV disease, the values were 91, 76, 65, and 52%, respectively. Conclusions: Three-field lymph node dissection may be indicated even for patients with clinical Stage I squamous cell carcinoma requiring surgical intervention because this surgical procedure provides for possible cure by removing unsuspected lymph node metastasis.     

胸中段食管鳞状细胞癌伴腹腔淋巴结转移及其预后的临床研究

目的 了解胸中段食管鳞状细胞癌伴腹腔淋巴结转移的方式,分析预后的影响因素.方法 对1998年1月至2003年1月接受手术治疗的368例胸中段食管鳞状细胞癌患者进行回顾性研究.本组男性289例,女性79例,年龄38～79岁,平均56岁.术前临床分期I～Ⅲ期.全部患者采用Ivor-Lewis手术(右胸及上腹部两切口)行食管大部切除加胸腹二野淋巴结清扫.全组患者平均随访时间68个月.结果 腹腔淋巴结转移58例(15.8%),其中T1-2患者占36.2%(21/58);有13.8%(8/58)的患者为跳跃性腹腔淋巴结转移,均发生在T1-2患者中.腹腔淋巴结转移患者5年生存率为10.3%,低于胸腔淋巴结转移患者的18.3%.远处腹腔淋巴结转移患者预后极差,无1例达到5年生存(0/16).COX多因素分析结果 显示,淋巴结转移数目≥5枚和远处腹腔淋巴结转移是腹腔淋巴结转移患者的独立预后因素.结论 胸中段食管癌腹腔淋巴结转移的发生率较高,应该选择有利于腹腔淋巴结广泛清扫的手术方式.腹腔淋巴结转移患者的预后不良,尤其淋巴结转移数目较多和远处淋巴结转移的患者预后更差.