Advantages and Disadvantages of Three-Field Dissection for Squamous Cell Carcinoma of the Thoracic Esophagus

Masahiko Tsurumaru, Harushi Udagawa, Yoshiaki Kajiyama, Kenji Tsutsumi, Yoshihiro Kinoshita, Takeshi Hayakawa, Toshihito Sawada, Masamichi Matsuda, Goro Watanabe, Hiroshi Akiyama

Department of Digestive Surgery, Toranomon Hospital

Six hundred thirty-three cases of squamous cell carcinoma of the thoracic esophagus were reviewed. Of these, 284 cases underwent two-field dissection (D2) and 348 cases received three-field dissection (D3). These two groups were analyzed in terms of the advantages and disadvantages of three-field dissection. The average number of lymph nodes resected per case was 36.9 for the D2 group and 110.5 for the D3 group. This difference of number implied that lymph node dissection was performed more extensively and more precisely in the D3 group than in the D2 group. A higher incidence of lymph node metastasis to n4 was observed in the D3 group, accounting for the possibility that distant node metastasis might remain in some patients in the D2 group. As a disadvantage of D3, postoperative pulmonary complications developed at a higher rate (26.4%) in the D3 group than in the D2 group (18.1%). The mortality rates within 30 postoperative days were 2.9% for the D3 group and 1.8% for the D2 group. However, the D3 group had a statistically significantly better 5 year survival rate even when both operative death and hospital death were included. In conclusion, D3 has great advantages in improving long term survival despite the high incidence of complications. It can be justifiably used as a standard procedure for radical surgery of carcinoma of thoracic esophagus.

Key words
esophageal carcinoma, three-field dissection, prognosis

Reprint requests
Masahiko Tsurumaru Department of Digestive Surgery, Toranomon Hospital
2-2-2 Toranomon, Minatoku, 105 JAPAN

Accepted
December 7, 1994

To read the PDF file you will need Abobe Reader installed on your computer.