Evaluation of Cervical and Extended Upper Mediastinal Lymph Node Dissection for Thoracic Esophageal Cancer in Relation to Radicality and Quality of Life

Katsu Hirayama, Tetsuro Nishihira, Takashi Akaishi, Ryuzaburo Shineha, Kazunori Sanekata, Norio Higuchi, Shozo Mori

The Second Department of Surgery, Tohoku University School of Medicine

Cervical and extended upper mediastinal lymph node dissection was evaluated in relation to radicality and quality of life. Between 1987 and 1991, 170 thoracic esophageal carcinomas were resected in our department. Of the patients, 42 satisfied out criteria regarding the local and general condition for cervical and extended upper mediastinal lymph node dissection. All of them received R-II or R-III lymph node dissection through right thoracotomy. Extended lymphadenectomy (21 patients) were compared with the conventional lymphadenectomy (21 patients) in regard to the postoperative hemodynamic state, pulmonary function and the performance status. There was one direct operative death in the conventional lymphadenectomy group, while there were no direct operative deaths in the extended lymphadenectomy group. There was no significant difference in postoperative hemodynmic state between the two groups. Damage to the cough reflex and the incidence of temporary recurrent laryngeal nerve palsy were significantly higher in the extended lymphadenectomy group than in the conventional lymphadenectomy group. Moreover, the rate of tracheotomy was significantly higher in the extended lymphadenectomy group. However, there was no significant difference in the incidence of pulmonary complication between the two groups. Patients surviving more than six months after the operation were asked about their life style, via a questionnaire. There were no significant differences in performance status, complaints or the dietary habits between the two groups. Although extended lymphadenectomy causes great surgical stress in pulmonary function, these results suggest that a high value should be placed on extended lymphadenectomy in relation to the quality of life.

Key words
thoracic esophageal cancer, quality of life of thoracic esophageal cancer, cervical and extended upper mediastinal lymph node dissection for thoracic esophageal cancer

Reprint requests
Katsu Hirayama The Second Department of Surgery, Tohoku University School of Medicine
1-1 Seiryo-cho, Aoba-ku, Sendai, 980 JAPAN

Accepted
July 6, 1992

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