Anatomical Evaluation of Possible Extent of Clearing Upper Mediastinal Lymph Nodes for Esophageal Cancer with Right Thoracotomy and Neck Dissection

Yutaka Funami, Kazuaki Okuyama, Noriyuki Tohnosu, Yoshio Koide, Tomotaka Awano, Hiromasa Matsubara, Kazuyuki Matsushita, Akio Sakamoto, Teruo Kozu, Atsuo Mikata¹⁾, Yoichiro Kondo²⁾, Yutaka Shimada³⁾, Kaichi Isono

Second Department of Surgery, First Department of Pathology¹⁾, Second Department of Pathology²⁾, and First Department of Anatomy³⁾, School of Medicine, Chiba University

Five cadavers were anatomically evaluated for the possibility of clearing upper mediastinal lymph nodes through right thoracotomy and neck dissection for esophageal cancer. Furthermore, the status of lymph node metastasis in the area difficult to clear due to a limited view of the operative field was pathologically analyzed using 25 cadavers after lymph node dissection in three areas of the neck, thoracic cavity and abdomen. The anatomical study of 5 cadavers revealed that the left sides of the upper mediastinal lymph nodes were completely cleared up to the median sides of the brachiocephalic artery, left common carotid artery, left subclavian artery, and Botallo's ligament. However, clearing the lymph nodes located on the left sides of the aorta, Botallo's ligament and pulmonary artery was very difficult; remaining lymph nodes were found after clearing. In the analysis of the 15 of 25 cadavers that could be evaluated, no metastatic lymph nodes were seen in the left sides of the aortic arch and Botallo's ligament, and therefore clearing these regions was considered not so advantageous. It was concluded that clearing of the upper mediastinal lymph nodes was enough in view of the operative field through right thoracotomy and neck dissection for esophageal cancer.

Key words
operation of esophageal cancer, clearing of upper mediastinal lymph nodes, approach of right thoracotomy and neck dissection, anatomical evaluation of the possibility of clearing, pathological evaluation of metastatic lymph nodes

Reprint requests
Yutaka Funami The Second Department of Surgery, Chiba University, School of Medicine
1-8-1 Inohana, Chuo-ku, Chiba-shi, 260 JAPAN

Accepted
April 14, 1993

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