Lymph Node Dissection for Thoracic Esophageal Carcinoma

Masahiko Tsurumaru

Department of Surgery, Toranomon Hospital

It is well known that thoracic esophageal carcinoma develops wide spread lymph node metastasis including the neck, mediastimum and abdomen. However, there has been no reliable randomized trials which gave the definite answer to the question to what extent lymph node dissection should be done for esophageal carcinoma in order to obtain better survival rate. Statistical analysis allows us to use Cox regression model to evaluate effectiveness of extensive lymph node dissection including the neck for better prognosis. Cox regression analysis suggested that extensive lymph node dissection might yield better survival rate with the risk ratio of 0.5501 compared to limited lymph node dissection. In this paper, radical operation for thoracic esophageal carcinoma will be discussed mainly concerning its procedures. According to studies on distribution of metastatic lymph nodes, three fields including the neck, mediastinum and abdomen were involved despite of location of a main tumor, though the rate of patients with metastatic node per patients dissected was different in accordance with a location of a main tumor. This is one of the evidences which require extensive lymph node dissection including the neck. The main part of lymph node dissection is continuous clearance along both sides of the recurrent laryngeal nerves in the upper mediastinum and the neck. In the neck, the region below the omohyoid muscle should be dissected because approximately 90% of metastatic nodes were included within this region. Meticulous procedures with patience would be mandatory for less postoperative morbidity.

Key words
esophageal carcinoma, lymph node dissection, three field dissection

Reprint requests
Masahiko Tsurumaru Department of Surgery, Toranomon Hospital
2-2-2 Toranomon, Minato-ku, Tokyo, 105 JAPAN

Accepted
November 5, 1997

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