Merits and Demerits due to 3-Field Dissection for Cancer of the Thoracic Esophagus

Nobutoshi Ando, Soji Ozawa, Kazuyuki Tsujizuka, Hiroharu Shinozaki, Yoshifumi Ikeda, Kazumasa Ueda, Masaki Kitajima

Department of Surgery, School of Medicine, Keio University

Ninety-two patients with cancer of the thoracic esophagus who underwent 3-field dissection (3F) from 1986 to 1992 were compared with 57 patients who underwent conventional 2-field dissection (2F) from 1982 to 1987 from the viewpoints of survival rates and postoperative complications. Analyzing the number of dissected nodes revealed that the degree of mediastinal dissection in 3F was more developed. No significant differences in overall survival rates were observed between 3F and 2F. However in the following cases, significant differences in survival rates were observed between 3F and 2F: cases of stage 0-III, cases in which the number of positive nodes was three or fewer, cases in which positive fields with lymph node netastasis were one or none and cases in which tumor location was the middle thoracic esophagus. That is to say, 3F was effective for moderately advanced cases, but not effective for far advanced cases. No significan differences in the incidence of postoperative complications, namely pulmonary complications and recurrent laryngeal nerve palsy, were observed between 3F and 2F. A satisfactory correlation was observed between c-erbB oncogene amplification and the number of positive nodes. Therefore, it would be possible to differentiate between moderately advanced and far advanced cases by preoperative estimation of lymph node metastasis. C-erbB oncogene would be useful for determining the indication for 3-field dissection.

Key words
esophageal cancer, 3-field dissection c-erb

Reprint requests
Nobutoshi Ando Department of Surgery, School of Medicine, Keio University
35 Shinanomachi, Shinjuku-ku, Tokyo, 160 JAPAN

Accepted
December 7, 1994

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