Advantage of Extended Lmyphadenectomy for Carcinoma of the Thoracic Esophagus

Hideaki Yamana, Teruo Kakegawa, Hiromasa Fujita, Ichiro Shima, Yuji Tou

First Department of Surgery, Kurume University School of Medicine

The advantage of extended lymphadenectomy for intrathoracic esophageal carcinomas was investigated in 301 patients who reveived radical surgery under the various types of lymphadenectomy, between 1975 and 1993. As time passed, the extent of lymph node dissection was gradually spread. Group A (n=39) underwent lower mediastinal and abdominal lymphadenectomy. Group B (n=30) underwentlymph node dissection around the right paratracheal, lower mediastinal and abdominal regions. Group C (n=114) underwent radical lymphadenectomy around the bilateral mediastinal and abdominal area. Group D (n=110) underwent extended radical lymph node dissection around the cervicothoracoabdominal area, and Group E (n=8) underwent especially extended lymphadenectomy along with total esophagectomy and laryngectomy due to massive lymph node metastasis in the cervicothoracic area. The postoperative survival rate improved according to extent except in Group E. Eight cases in Group E had severe lymphgenous metastasis to the cervicothoracic region with an average of 16 positive nodes. Patients who survived well for more than 5 years, had lymph node metastasis within 3 nodes regardless of the extent of lymphadenectomy. On the other hand, several patients with involvement of 4 to 10 nodes survived more than 3 years by undergoing extended radical lymphadenectomy. Almost all patients with involvement of more than 10 nodes died of early recurrence. Comparing the incidence of postoperative complications between Groups C and D, Group D showed a higher percentage of recurrent nerve paralysis, while no differences were found in other complications. Operative and hospital mortality showed no differences between the 2 groups. These results indicate that extended lymphadenectomy (3-field dissection) may improve patients' prognosis when they have intermediate advanced carcinoma of the thoracic esophagus.

Key words
intrathoracic esophageal carcinoma, extended radical lymphadenectomy, postoperative survival rate

Reprint requests
Hideaki Yamana First Department of Surgery, Kurume University School of Medicine
67 Asahimachi, Kurume, 830 JAPAN

Accepted
December 7, 1994

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