Indication of Cervical Lypmh Node Dissection for Thoracic Esophageal Carcinoma According to Preoperative Diagnosis with Ultrasonic Examination

Toshitaka Fukumoto, Heiji Yoshinaka, Toshiyuki Morinaga, Shouji Natsugoe, Kazunobu Tokuda, Mario Shimada, Kazusada Shirao, Chikara Kusano, Masamichi Baba, Takashi Aikou

First Department of Surgery, Faculty of Medicine, Kagoshima University

In this series, the indication for cervical lymph node dissection for thoracic esophageal carcinoma was investigated by preoperative ultrasonic examination of nodal metastasis at supraclavicular and recurrent nerve chain nodes. During the period from January 1986 to December 1993, a total of 136 patients with thoracic esophageal carcinoma were curatively operated on by right thoracotomy and laparotomy. Of these, 105 patients underwent 3-field lymph node dissection and 31 underwent 2-field dissection. 1) Lymph node metastasis was detected histopathologically in 7 of 84 patients who were assessed preoperatively as having no metastasis of the supraclavicular node. 2) Five of these 7 false negative patients were also assessed preoperatively or during operation as having metastasis of the recurrent nerve chain nodes. 3) And so, it is risky to determine the cervical lymph node dissection only by assessment of supraclavicular lymph node. However,in 97% of patients (82/84 cases), it is possible to determine the indication of cervical lymph adenectomy, adding to assessment of recurrent nerve chain node. 4) For patients in whom the tumor invaded beyond the proper muscularis, the 5-year survival rates were 37% in cervical lymph node dissection group, similar to those of no dissection group. 5) The indication of cervical lymphadenectomy is for such patients assessed preoperatively as having metastasis of the supraclavicular or recurrent nerve chain node.

Key words
3-field lymph node dissection, ultrasonography, endoscopic ultrasonography, preoperative diagnosis

Reprint requests
Toshitaka Fukumoto First Department of Surgery, Faculty of Medicine, Kagoshima University
8-35-1 Sakuragaoka, Kagoshima, 890 JAPAN

Accepted
May 8, 1996

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