Study on Surgecal Treatment of Carcinoma of Lower Thoracic Esophagus

Osamu Konno, Hitoshi Inoue, Michihiko Kogure, Yoshiharu Haga, Koumei Sagawa, Fujio Itoh, Tohru Tezuka, Masamitsu Ogata, Shinya Terashima, Ryoichi Motoki

First Department of Surgery, Fukushima Medical College

The results of surgical treatment of lower thoracic esopageal cancer were studied by comparison of 19 patients who received a lower esophageal resection and intrathoracic esophago-gastrostomy (Group A) and 21 patients who received a subtotal esophagectomy and cervical esohago-gastrostomy (Group B). The effect of lymphadenectomy in the cervical and upper mediastinal regions was retrospectively evaluated. Abdominal lymph node (LN) metastasis was observed most frequently. The rate of metastasis in the upper thoracic paraesophageal LN was 21% and it was 5% in the paratracheal LN in group B. The postoperative 5-year survival rate was better in Group B than in Group A (47% vs 21% overall, and 33.3% vs 14.3% in patients in stage III and IV). In Group B, the cumulative 5-year survival rates were 59.9% and 49.9% for patients with n (-)∼n₂ (+) and those with n_3∼4 (+) respectively. These results suggest that upper mediastinal lymphadenectomy is very important in cases of lower thoracic esophageal cancer. Liver metastasis was the most frequent site of recurrence. Cervical LN metastasis was observed in a few cases, but we concluded that cervical lymphadenectomy is indicated even for patients suspected of having cervical LN metastasis by preoperative examination or who have upper mediastinal LN metastasis detected during surgery.

Key words
carcinoma of lower thoracic esophagus, intrathoracic esophagogastrostomy, lymphnode metastasis of esophageal cancer, dissection of cervical lymphnodes

Reprint requests
Osamu Konno First Department of Surgery, Fukushima Medical College
1 Hikarigaoka, Fukushima, 960-12 JAPAN

Accepted
May 9, 1990

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