下咽頭・頸部食道癌の臨床的検討—当科における過去10年間の治療経験

Clinical Analysis of Cancers of the Hypopharynx and Cervical Esophagus

　緒言

　下咽頭および頸部食道癌は頭頸部腫瘍の中で症例数は少ないもののその予後はとりわけ不良であり，頭頸部外科の各施設において常に課題となる疾患群である。近接する喉頭癌の治療成績が向上する中で，さらに手術手技が開発されているにも拘わらず，依然として予後を向上させられないのが現実である。その理由は既に諸家^1-3）においても検討されてはいるが，今回われわれは三重大学耳鼻咽喉科において行われた下咽頭・頸部食道癌治療症例を検討し，治療成績の向上に何が欠けているのかを明瞭にするべく，若干の文献的考察を加え報告する。

Fifty four patients with the hypopharyngeal and cervical esophageal cancer were treated in our clinic from July 1982 to June 1991. They consisted of 17 cases of T2, 10 of T3, and 9 of and treated by surgery or radiotherapy.

Our regimen for these diseases was combined therapy with chemotherapy, radiotherapy and surgery. The surgical procedures were resection of pharyngolaryngoesophagectomy with bilateral neck dissection.

Among all these cases, 36 cases were treated surgically, and the accumulated survival rate was 31.9%.

In spite of resection with 2 or 3 cm of the upper and lower surgical safety margins, recurrence was noted in the mesopharynx, and in spite of bila-teral neck dissections, recurrence of cervical lym-ph nodes were noted in the upper jugular area.