根治的放射線化学療法後に胸腔鏡下リンパ節郭清術を行った食道癌の3例

Thoracoscopic lymphadenectomy after definitive chemoradiation therapy for the treatment of esophageal cancer

◆要旨：食道癌に対する放射線化学療法（CRT）後に，原発巣はcomplete response （CR） であるものの，リンパ節にのみ腫瘍が遺残する症例も存在する．初回治療として根治的CRTを行った症例のうち，原発巣CRで右反回神経周囲リンパ節（106recR）にCT上遺残・再発を認めた3症例に対して胸腔鏡下リンパ節郭清術を施行した．病理組織学的検討では3例中2例に癌細胞を認めた．胸腔鏡下リンパ節郭清術は，低侵襲でリンパ節遺残の有無を確実に判定できるうえに，その後食道切除再建術が必要となった場合でも対応可能なことから，CRT後のsalvage治療の選択肢の1つとして検討されるべきものと考えられた．

As the number of esophageal cancer patients treated with definitive chemoradiation therapy （CRT）increase, the need for salvage surgery has also increased. In some cases, only metastatic lymph nodes remained after CRT, although the original tumor in the esophagus completely disappeared. Metastasis in the right recurrent nerve lymph nodes is frequently observed during the treatment of esophageal cancer. We report three patients who underwent thoracoscopic lymphadenectomy to remove tumors in the right recurrent nerve lymph nodes. Histopathological analysis revealed metastatic lymph nodes in two cases. Thoracoscopic lymphadenectomy is thought to be very useful surgical procedure since it is minimally invasive, reduces pleural adhesion, and enables salvage esophagectomy even after lymphadenectomy.