Extended Lymph Node Dissection for Thoracic Esophageal Cancer -Efficacy of Three Field Dissection Based on Preoperative Staging-

Hiroko Ide, Reiki Eguchi, Tsutomu Nakamura, Kazuhiko Hayashi, Kazunari Yoshida, Tomoko Hanashi, Ataru Kobayashi, Hidemi Nakamura, Keishi Tanigawa, Tetsuya Kikuchi, Masaho Oota, Fujio Hanyu

Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical College

We studied the surgical results and prognoses of 426 patients with thoracic esophageal cancer who underwent esophagectomy from May 1985 to 1993. Of these, 184 patients had three-field lymph node dissection (3F), 137 patients had two-field dissection with extended upper-mediastinal node dissection (2F), and 105 patients had two-field dissection with standard mediastinal node dissection (2S). We indicated 3F for patients with upper thoracic esophageal cancer, those diagnosed with cervical node metastasis by ultrasonography (US), and those with upper mediastinal node metastasis. The rate of lymph node metastasis was 80.9% (30.4%: cervical) in 3F, 60.9%, in 2F, and 56.2% in 2S. Motality rates were not different among the 3 groups. The cumulative 5-year survival rate after employment of 3F, 40.2%, was improved compared with the one before, 23.4% (p<0.0001). The cumulative 5-year survival rates of patients (C>0) in 3F, 2F, and 2S were 42.9%, 56.5%, and 40.4%, respectively. The prognosis of 3F was better than that of 2F in patients with lymph node metastasis, those in stage IV, and those with 1-3 metastatic nodes. The 5-year survival rate of patients with cervical node metastasis in 3F was 3l.3%, similar to those in patients with mediastinal or abdominal node metastasis. This showed that cervical node dissection was beneficial for the survival of patients with cervical node metastasis. On the other hand, there was no difference in survival between 3F and 2F in patients who did not have metastatic lymph nodes or those with submucosal cancer. These facts suggest that our indication for 3-field dissection based on preoperative staging might be effective to improve the survival of patients with thoracic esophageal cancer.

Key words
operation for thoracic esophageal cancer, three field dissection, five-year survival rate

Reprint requests
Hiroko Ide The Institute of Gastroenterology, Tokyo Women's Medical College
8-1 Kawadacho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
December 7, 1994

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