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EndoTODAY ³»½Ã°æ ±³½Ç


[½Äµµ¾Ï ȯÀÚÀÇ ¸²ÇÁÀý ¸í¸í¹ý]

1. ½Äµµ squamous cell carcinomaÀÇ ¸²ÇÁÀý ÀüÀÌ À§Çè

½Äµµ squamous cell carcinomaÀÇ ¸²ÇÁÀý ÀüÀÌ À§ÇèÀº À§³ª ´ëÀ庸´Ù ÈξÀ ³ô½À´Ï´Ù (EndoTODAY 20121223). ¼ö ³â Àü »ï¼º¼­¿ïº´¿øÀÇ ÀڷḦ ºÐ¼®ÇÑ ¹Ù ÀÖ½À´Ï´Ù (Kim DU. J Gastroenterol Hepatol 2008). ÇÙ½É ±×·¥À» ¾Æ·¡¿¡ ¿Å±é´Ï´Ù.

M3 ¾Ï¿¡¼­µµ ¸²ÇÁÀý À§ÇèÀÌ »ó´çÈ÷ ³ô´Ù´Âµ¥ À¯ÀÇÇØ¾ß ÇÏ°Ú½À´Ï´Ù. ¿¬±¸ ±â°£ ´ë»óȯÀÚ¿¡¼­´Â ¾ø¾úÁö¸¸, °£È¤ M2¾Ï¿¡¼­ ¸²ÇÁÀý ÀüÀ̸¦ º¸ÀÌ´Â Áõ·Ê¸¦ ¸¸³ª±âµµ ÇÕ´Ï´Ù.


2. ½Äµµ¾Ï ȯÀÚÀÇ ¸²ÇÁÀý ¸í¸í¹ý

½Äµµ¾Ï ȯÀÚÀÇ ¸²ÇÁÀý ¸í¸í¹ýÀº Å©°Ô ¼­¾ç½Ä(AJCC)°ú ÀϺ»½Ä(ÀϺ»½ÄµµÁúȯÇÐȸ, ÀϺ»À§¾ÏÇÐȸ)ÀÌ ÀÖ½À´Ï´Ù.

1) AJCC 7ÆÇ¿¡ µû¸¥ ¸²ÇÁÀý ¸í¸í¹ý

1L = left supraclavicular, 1R = right supraclavicular, 2L = left upper paratracheal, 2R = right upper paratracheal, 4L = left lower paratracheal, 4R = right lower paratracheal, 5 = aortopulmonary, 6 = anterior mediastinal, 7 = subcarinal, 8L = lower paraesophageal, 8M = middle paraesophageal, 9 = pulmonary ligament, 10L = left tracheobronchial, 10R = right tracheobronchial, 15 = diaphragmatic, 16 = paracardial, 17 = left gastric, 18 = common hepatic, 19 = splenic, 20 = celiac. The posterior mediastinal lymph node (3P) is not shown.

ÈäºÎ¿Ü°ú¿¡¼­´Â °ü·ÊÀûÀ¸·Î recurrent laryngeal nerve lymph node¶ó°í ºÎ¸£´Â ¿¹°¡ ¸¹½À´Ï´Ù.
- Right recurrent laryngeal node (RRLN): 2R
- Left recurrent laryngeal node (LRLN): 4L


2) ÀϺ» ½ÄµµÁúȯÇÐȸ ¸²ÇÁÀý ¸í¸í¹ý (Esophagus 2004;1:61-88)


3) ÀϺ» À§¾ÏÇÐȸ ¸²ÇÁÀý ¸í¸í¹ý

17 = lymph nodes on the anterior surface of the pancreatic head, 18 = lymph nodes along the inferior margin of the pancreas, 19 = lnfradiaphragmatic lymph nodes, 20 = lymph nodes in the esophagus hiatus of the diaphragm, 110 = lower throacic paraesophageal nodes, 111 = supradiaphragmatic lymph nodes, 112 = posterior mediastinal nodes


4) ¼­¾ç½Ä°ú ÀϺ»½ÄÀÇ ºñ±³

Barrett adenocarcinoma³ª cardia cancerÀÇ ¼ö¼ú¿¡ ´ëÇÏ¿© ÈäºÎ¿Ü°ú³ª ÀϹݿܰú ÀÇ»ç¿Í ´ëÈ­ÇÒ ¶§ ¸²ÇÁÀý ¹Ú¸® ¹üÀ§¸¦ ³íÇϱâ´Â ½±Áö ¾Ê½À´Ï´Ù. ƯÈ÷ ÈäºÎ¿Ü°ú¿¡¼­ »ç¿ëÇÏ´Â ¿ë¾î¿Í ÀϹݿܰú¿¡¼­ »ç¿ëÇÏ´Â ¿ë¾î°¡ ´Ù¸£±â ¶§¹®ÀÔ´Ï´Ù. ÈäºÎ¿Ü°ú¿¡¼­´Â ¹Ì±¹½Ä ¼ýÀÚ¸¦ »ç¿ëÇÏ°í ÀϹݿܰú¿¡¼­´Â ÀϺ»½Ä ¼ýÀÚ¸¦ »ç¿ëÇϱ⠶§¹®ÀÔ´Ï´Ù. ¿¹¸¦ µé¾î lower paratracheal nodes´Â ¹Ì±¹½ÄÀ¸·Î´Â 8L¹ø, ÀϺ»½ÄÀ¸·Î´Â 110¹øÀÔ´Ï´Ù.

À§Ä¡¼­¾ç½ÄÀϺ»½Ä
Lower paratracheal nodes8L110
Diaphragmatic nodes15111
Paracardial nodes161 (éÓ) ¶Ç´Â 2 (ñ§)


4. »ï¼º¼­¿ïº´¿ø ½Äµµ¾Ï ȯÀÚ ¸²ÇÁÀý ¸í¸í¹ý

»ï¼º¼­¿ïº´¿øÀÇ LN mapÀº ±âº»ÀûÀ¸·Î AJCC¿Í À¯»çÇϸç, ¼ýÀÚº¸´Ù´Â À§Ä¡¿¡ ¸Â´Â ¸íĪÀ¸·Î º¯È¯ÇÏ¿© »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. º¹ºÎ ¸²ÇÁÀýÀº º´¿ø¿¡¼­ º°µµÀÇ À̸§À» ºÎ¿©ÇÏ¿© °ü¸®ÇÏ°í ÀÖ½À´Ï´Ù.


ÇϺΠ½Äµµ¾ÏÀº Á¾Á¾ intraabdominal lymph node·Î ÀüÀÌÇÒ ¼ö ÀÖ½À´Ï´Ù. ¾Æ·¡ Áõ·Ê¿¡¼­´Â common hepatic artery node (G1) ÀüÀÌ°¡ ÀÖ¾ú½À´Ï´Ù. ÀÌ È¯ÀÚ´Â ¼±¾ÏÀ̾ú½À´Ï´Ù. ÇϺΠ½Äµµ ¼±¾Ï. ¸Å¿ì º¸±â Èûµç °æ¿ìÀÔ´Ï´Ù.


Esophagus and upper stomach, Ivor Lewis operation:
Adenocarcinoma, moderately differentiated, lower thoracic esophagus (esophagogastric junction) ;
1) tumor size: 2.5x2.5 cm
2) extension to periesophageal soft tissue (adventitia)
3) endolymphatic tumor emboli: not identified
4) perineural invasion: present
5) resection margins: free from carcinoma, safety margin: proximal, 7.5 cm ; distal. 2 cm ;
6) metastasis to 1 out of 21 regional lymph nodes (1/21: "7(subcarinal)" for frozen section-1, 0/6; "Gastric lymph node 1", 1/1; "Gastric lymph node 2", 0/3; "Lt Recurrent Laryngeal Nerve LN", 0/2; "Rt Recurrent Laryngeal Nerve LN", 0/2; periesophageal LN, 0/7)
7) treatment effect: no prior treatment

¾Æ·¡ Áõ·Ê´Â squamous cell carcinoma¿´½À´Ï´Ù. G3, Áï left gastric artery lymph node ÀüÀÌ°¡ ÀÖ¾ú½À´Ï´Ù.

¾Æ·¡ Áõ·Ê´Â G4, Áï paracardial node ÀüÀÌ°¡ ÀÖ¾ú½À´Ï´Ù.


Esophagus and upper stomach, Ivor Lewis operation : Invasive squamous cell carcinoma, moderately differentiated, middle thoracic esophagus :
1) tumor size: 2.9x1.2 cm
2) extension to submucosa
3) endolymphatic tumor emboli: not identified
4) perineural invasion: not identified
5) resection margins: free from carcinoma, safety margin: proximal, 2 cm ; distal, 5 cm ; circumferential (adventitial) margin(deep), 0.6 cm
6) metastasis to 1 out of 42 regional lymph nodes (1/42: "RRLN", 0/11; "LRLN", 0/2; "4L", 0/2; "8u", 0/1; "8d", 0/1; "7", 0/5; "G1", 0/3; "G3", 0/14; "G4", 1/3)
7) treatment effect: no prior treatment


[References]

1) Takubo K. Histopathological diagnosis of adenocarcinoma in Barrett's esophagus. Dig Endosc 2014;26:322-30.



© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.