식도암 환자의 수술전 평가에서 기관지내시경의 역할 = The Role of Flexible Bronchoscopy in the Preoperative Evaluation of Esophageal Cancer Patients

다국어 초록 (Multilingual Abstract)

Objective: For curative surgical treatment of esophageal cancer the resectability from the tracheobrochial tree would be the most important factor. Although CT scan has been used for the determination of the resectability of esophageal cancer, it has a limitation on the detection of esophageal cancer invasion to tracheobronchial tree We have performed flexible bronchoscopy in the patients with esophageal cancer to detect and classify the tracheobronchial tree alterations and to find the relation of bronchoscopic findings with the resectability. Method: From April 1990 to October 1992, 133 patients with esophageal cancer had received bronchoscopy. Bronchoscopic findings were classified into three groups: [Group I: normal, Group II: indirect effects (hyperemia and compression-mild, moderate, severe), group III: invasion). CT findings were a]so classified into three classes: [Class A: tumor separated from tracheobronehial tree, Class B: abutting tree, Class C: compressing tree]. We investigated the resectability of esophageal cancer according to bronchoscopic and CT findings. Results: 1) Among 133 patients, the bronchscopic findings were Group I in 41(30.8%), Group II in 66(49.6%), and Group III in 26(19.6%) patients. 2) Abnormal bronchoscopic findings were mainly found in trachea and left main bronchus and frequently found in upper and middle esophageal cancer patients, 3) The resection rate from tracheobronchial tree was 96.8% in group I and 75% in group II bronchoscopic finding. 4) The resections from tracheobronchial tree could be performed in 94.6% of Class A, in 70% of Class B and in 53.8% of Class C of CT scan patients. 5) Six of twelve unresectable patients belonged to Class C of CT scan finding If we excluded Class C in Group II patients, resectability would be increased to 87.5%. Conclusion: We could recommend the operation in esophgeal cancer patients with Group I and minimal Group II bronchoscopic finding. In advanced Group II and/or Class C of CT scan patients, neoadjuvant treatment and reevaluation could be recommended.