Pattern of Lymphatic Metastasis to the Upper Mediastinum in Cancer of the Thoracic Esophagus-Analysis of Computed Tomography Findings in Unresectable Cases-

Toshiki Matsubara

Department of Surgery, Cancer Institute Hospital

To clarify the pattern of mediastinal lymphatic metastasis in cancer of the thoracic esophagus, the distribution of positive lymph nodes on CT was investigated in 50 patients whose tumors were clinically unresectable because of too advanced disease. Lymph nodes along the recurrent laryngeal nerves and subcarinal nodes were classified as the primary drainage nodes. It was suggested that the following lymphatic routes are involved in further lymphatic extension: from the right recurrent laryngeal nerve nodes to the right deep cervical nodes or right upper pretracheal nodes, from the right upper pretracheal nodes or subcarinal nodes to the right lower pretracheal nodes, and from the left tracheobronchial nodes to the subaortic nodes. When the left deep cervical nodes, lower pretracheal nodes, anterior mediastinal nodes, subaortic nodes or preaortic nodes were positive on CT, the disease was extremely advanced. However, in patients, presenting palpable right deep cervical involvement or right recurrent laryngeal nerve palsy, the cancer was occasionally not so extensive on CT as to be regarded as unresectable.

Key words
esophageal neoplasm, computed tomography in esophageal cancer, staging of esophageal cancer, surgery for cancer of the thoracic esophagus, lymph node metastasis in esophageal cancer

Reprint requests
Toshiki Matsubara Department of Surgery, Cancer Institute Hospital
1-37-1 Kamiikebukuro, Toshima-ku, Tokyo, 170 JAPAN

Accepted
April 11, 1990

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