Rational Compromise Operation for Cancer of the Thoracic Esophagus

Toshiki Matsubara, Mamoru Ueda, Sakae Okumura, Toshifusa Nakajima, Mitsumasa Nishi

Department of Gastroenterological Surgery, Cancer Institute Hospital

The clinical features including the distribution pattern of involved lymph nodes were investigated in 131 patients undergoing our standard systematic lymph node dissection (the cervico-abdomino-thoracal approach) and in 18 patients undergoing limited operation (less aggressive but including the cervical approach), to establish reasonable compromise dissection procedures for various poor risk patients. When the preoperative evaluation of the lymph node state was negative (preoperative No) and cancer did not penetrate the esophageal proper muscle (a₀ cancer), there was no nodal involvement in the middle and lower mediastinum (MLM). In a₀ or preoperative No cancer, MLM nodes were less frequently involved than nodes along the recurrent nerves (RN nodes) or nodes at the upper stomach (US nodes) including the celiac nodes. When neither RN nor US nodes were histologically positive, the incidence of MLM node involvement was low (0% in a₀ cancer). Cancer recurrence in the MLM was not found in a₀ cancer. Cancer did not recurred in the mediastinum in patients undergoing limited operations, except those with too extensive disease. These findings suggest that RN and US node dissections are substantial even in limited surgery. Less aggressive operations through left thoracotomy or without thoracotomy are a rational compromise for earlier stage cancer, especially a₀ or preoperative No cancer.

Key words
esophageal cancer, limited operation for esophageal cancer, surgery for cancer of the thoracic esophagus, lymph node dissection in cancer of the thoracic esophagus

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

Accepted
October 7, 1992

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