Recurrence of Thoracic Esophageal Cancer after Lymph Node Dissection in Three Areas -With Special Reference to the Relationship between Recurrence and the Number of Metastatic Lymph Nodes-

Shoji Natsugoe, Hisaaki Shimazu, Masamichi Baba, Heiji Yoshinaka, Mario Shimada, Yusei Haraguchi, Kazusada Shirao, Gen Tanabe, Toshitaka Fukumoto, Takashi Aikou

First Department of Surgery, Kagoshima University School of Medicine

Ninety-seven patients with thoracic esophageal cancer underwent subtotal esophagectomy and lymph node dissection of three areas, i.e., cervical, mediastinal and abdominal. The operations were all judged curative resections. Recurrence occurred postoperatively in 43 patients (44.3%). The patients with recurrence were divided into two groups according to whether the number of metastatic lymph nodes was 5 or less (group 1) or 6 or more (group 2). Group 1 included 25 patients, and group 2, 18 patients. The time interval from operation to recurrence was shorter in group 2 than in group 1. Of all 43 patients with recurrence, lymph node recurrence occurred in 21 cases, visceral recurrence in 15 cases, and both lymph node and visceral recurrence in 3 cases; miscellaneous recurrence was observed in 4 cases. Upper mediastinal lymph node recurrence was found in a considerable number of cases, including 4 of 6 cases without lymph node metastasis at the time of operation. In 7 of 9 cases in group 2, lymph node recurrence occurred in the left upper mediastinum. Lymph node metastasis had been present in all cases. All the visceral recurrences occurred in cases with lymph node metastasis, which extended to more than two areas in 80% of the cases. The prognosis of patients with recurrence was poor, especially in those with both lymph node and visceral recurrences and with visceral recurrence in group 2. Four patients with lymph node recurrence have survived more than 4 years postoperatively. The indications for extended lymph node dissection and the option of combined therapy should be studied further, taking account of the number of metastatic lymph nodes.

Key words
thoracic esophageal cancer, number of metastatic lymph nodes, lymph node dissection, recurrence of esophageal cancer

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

Accepted
September 4, 1991

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