術後6年で頸部リンパ節再発したm3食道表在癌の1例

Cervical Neck Lymph Node Recurrence of Superficial Esophageal Cancer with m3 Invasion 6 years after the Operation, Report of a Case

要旨　患者は58歳，男性．Mt領域，0-Ⅱc型食道表在癌にて，52歳時（1993年1月），右開胸食道亜全摘，胸骨後胃管再建術施行，リンパ節は中縦隔のみpick up郭清した．病理組織学的には，扁平上皮癌，深達度m3でありリンパ節転移は認めなかった．術後経過順調で退院，以後近医で通院加療中であった．1999年に入り頸部リンパ節腫脹に気づき当科紹介受診．頸部CTで左頸部から一部上縦隔に及ぶリンパ節腫脹を認め，食道癌頸部リンパ節再発と診断し，5回の化学療法および化学放射線療法を施行し，約2年間の長期のNCを維持できた．本症例は，m3食道癌頸部～上縦隔リンパ節再発症例であり，手術時の上縦隔リンパ節郭清の重要性を再認識させられるとともに，化学療法および化学放射線療法が延命に寄与できたことを証明した症例であった．

　A 58-year-old man was admitted to our hospital with enlargement of the left cervical lymph nodes and hoarsenes. He had undergone subtotal esophagectomy using right thoracotomy with retrosternal gastric tube replacement at the age of 52 years (6 years earlier). Lymph node dissection was performed only in the middle mediastinum. Pathological examination revealed the squamous cell carcinoma with m3 invasion, but no lymph node metastasis was noted at that time. He was followed up by another hospital for 6 years, but was readmitted to our hospital with the above mentioned symptoms in May, 1999. He received 5 courses of chemotherapy, including or chemoradiotherapy and had been maintained in NC status for 2 years. This case emphasizes the importance of lymph node dissection in the upper mediastinum. In addition, this was a case where chemotherapy, including chemoradiotherapy was able to prolong the period of the patient's survival.