Özofagus malignite tanısı ile özofajektomi yapılan hastalarda metastatik lenf nodu sayısının sağkalıma etkisi /
Yazar: AYGUN ALIYEVA
Danışman: YRD. DOÇ. DR. MÜMİN COŞKUN
Marmara Üniversitesi / Tıp Fakültesi / Genel Cerrahi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2023
Konu: Genel Cerrahi = General Surgery

Özet:
Giriş ve Amaç: Özofagus kanseri mortalitesi yüksek seyreden bir kanser türüdür.
Metastatik lenf nodunun özofagus kanserlerinde prognoza etkili olduğu bilinmektedir.
Ancak metastatik LN sayısı ve pozitif tutulumlu lenf nodlarının total LN' ye oranı
sağkalıma olumsuz etkisi üzerinde henüz tek başına prognostik değer olarak kabul
edilmemektedir. Bu çalışmada kliniğimizde opere edilen özofagus kanseri hastalarında
bu iki değerin sağkalıma etkileri araştırıldı.
Gereç ve Yöntem: Ocak 2012-Aralık 2022 tarihleri arasında Marmara Üniversitesi
Pendik Eğitim ve Araştırma Hastanesi Genel Cerrahi kliniğinde özofagus kanseri
tanısı almış ve opere olan hastalar çalışmaya alınmıştır. Hastaların bilgileri hastane
sistemi üzerinden prospektif toplanarak retrospektif değerlendirilmiştir. Patoloji
raporları değerlendirilerek metastatik LN sayısı ve metastatik LN/total LN değeri
belirlendi ve sağkalıma etkisi araştırıldı.
Bulgular: Çalışmaya alınan 67 hastanın 38'i erkek, 29'u kadın, ortanca yaşları ESCC
ve EAC için 58.9 ve 56,9 olarak hesaplanmıştır. 37 hasta neoadjuvan tedavi almamış,
28 hasta neoadjuvan almış, tedavi sonrası ameliyat olmuş. EAC hastalarında
maksimum sağkalım 97 ay, ESCC'de ise 103 ay olarak saptandı. Fakat histopatolojik
olarak tipler arasında sağkalımda anlamlı fark görülmedi. Pozitif LN çıkarılan
hastaların sağkalımı 39 ay, negatif LN ise bu süre 62 ay olarak tespit edildi.
Çalışmamızda EAC için ortalama 22, ESCC için 18 LN eksize edilmiştir. Toplamda
ortalama 20± 2 LN eksize edildi. Hastaların morbidite skorlaması Clavien Dindo
klasifikasyonuna göre 3a> ve 3a

Abstract:
Introduction and Purpose: Esophageal cancer is a type of cancer with a high
mortality rate. It is known to be effective on prognosis in metastatic lymph node
esophageal cancers. However, the number of metastatic LNs and the ratio of positively
involved lymph nodes to total LN are not yet considered as prognostic values alone on
the negative impact on survival. In this study, the effects of these two values on
survival were investigated in patients with esophageal cancer who were operated on in
our clinic.
Materials and Methods: Patients who were diagnosed with esophageal cancer and
operated on in Marmara University Pendik Training and Research Hospital General
Surgery Clinic between January 2012 and December 2022 were included in the study.
The information of the patients was collected prospectively through the hospital
system and evaluated retrospectively. By evaluating the pathology reports, the number
of metastatic LN and metastatic LN/total LN value were determined and the effect on
survival was investigated.
Findings: The 67 patients were included in the study, 38 of them were male, 29 were
female, and the median ages for ESCC and EAC were calculated as 58.9 and 56.9
years. 37 patients did not receive neoadjuvant therapy, 28 patients received
neoadjuvant therapy and underwent surgery after treatment. Maximum survival was
97 months in EAC patients and 103 months in ESCC. However, histopathologically,
there was no significant difference in survival between the types. The survival of
patients with positive LN removal was 39 months, and this period was 62 months for
negative LN. In our study, an average of 22 LNs were excised for EAC and 18 LNs
for ESCC. In total, a mean of 20±2 LNs were excised. The morbidity scoring of the
patients was divided into 2 classes as 3a> and 3a< according to the Clavien Dindo
classification. Uni- and multivariate analyzes were performed with Clavien Dindo
scoring, neoadjuvant treatment effect, and positive LN count. Although these
parameters were found to be effective on survival as a result of the univariate analysis,
only the Clavien Dindo classification was found to be significant in the multivariate
analysis.

v
Conclusion: The total number resected showed a significant decrease in survival as
the percentage of positive nodes increased. The mean survival time was found to be
39 months. In addition, the number of negative LNs removed had a positive effect on
survival, resulting in a mean survival time of 62.6 months. The metastatic LN/total LN
ratio was 15%, and as this ratio decreased, survival increased. Although the effect of
the number of metastatic LN on survival was insignificant as a result of the
multivariate analysis, this parameter was found to be significant as a result of the
univariate analysis. It is predicted that the absolute number of metastatic LN will be
considered as the standard prognostic value in esophageal cancer, and it will be
supported by other studies. Patients undergoing surgery for esophageal cancer should
be staged based on the total number of metastatic lymph nodes and their proportion,
as this predicts survival more accurately than current staging systems.