Lymph Node Metastasis and Ultrasonic Detection in Patients with Esophageal Cancer Who Underwent Esophagectomy with Nodal Dissection in Three Areas

Heiji Yoshinaka, Hisaaki Shimazu, Toshiyuki Morinaga, Kazusada Shirao, Shoji Natsugoe, Masamichi Baba, Toshitaka Fukumoto

First Department of Surgery, Kagoshima University School of Medicine

Histopathological status and preoperative assessment were evaluated for lymph node metastasis using conventional and/or endoscopic ultrasonography in 104 patients with thoracic esophageal cancer. Nodal clearance was carried out in three areas, i.e., cervical, mediastinal and abdominal, in all cases. Lymph node metastasis was found in 73 patients (70.2%) by histological examination of surgically removed nodes. The incidence of nodal involvement was 23.1% in the supraclavicular region, 31.7% in the thoracocervical transitional, 30.8% in the upper mediastinal, 22.l% in the middle mediastinal, 17.3% in the lower mediastinal, 38.5% in the perigastric, 19.2% in the celiac and 3.8% in the para-aortic region. Lymph nodes in the supraclavicular, transitional and upper mediastinal regions were more frequently involved in patients with cancer located in upper intrathoracic esophagus. On the other hand, perigastric nodes were frequently involved in those with lower intrathoracic esophageal cancer. The sensitivity of ultrasonography was 75.0% in the supraclavicular region, 60.6% in the transitional, 76.9% in the upper mediastinal, 71.4% in the middle mediastinal, 0% in the lower mediastinal, 67.5% in the perigastric, 65.0% in the celiac and 100% in the para-aortic region. Specificity was more than 80% in all the regions. Although conventional and/or endoscopic ultrasonography is useful in screening esophageal cancer for lymph node metastasis, neither the surgical option nor the area to be dissected can be defined precisely by the measure itself.

Key words
lymph node metastasis in esophageal cancer, ultrasonic detection for lymph node metastasis, conventional ultrasonography, endoscopic ultrasonography, bilateral modified neck dissection

Reprint requests
Heiji Yoshinaka First Department of Surgery, Kagoshima University School of Medicine
8-35-1 Sakuragaoka, Kagoshima, 890 JAPAN

Accepted
September 4, 1991

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