Rational Extent of Lymphadenectomy Based on the Anatomic Characteristics of Lymph Node Metastasis in Potentially Curable Esophageal Cancer

Tadashi Nishimaki, Tsutomu Suzuki, Tatsuo Kanda, Tatsuhiko Hayashi, Shin-ichi Kosugi, Naozumi Watanabe, Shintaro Komukai and Katsuyoshi Hatakeyama

The First Department of Surgery, Niigata University School of Medicine

To determine the adequate extent of lymphadenectomy in radical esophagectomy for esophageal cancer, anatomic characteristics of lymph node metastasis patterns were studied according to the primary sites in 86 patients with esophageal cancer who had favorable grade nodal status, i.e. one to four positive nodes, after extended three-field lymphadenectomy. All of 5 patients with upper esophageal tumors had metastases to the cervical paraesophageal lymph nodes. Metastases to the cervical, mediastinal, and abdominal lymph nodes were found in 6.5%, 64.5%, and 58.1% of 31 patients with lower esophageal tumors, respectively. Metastases were confined to the lower mediastinal lymph nodes in 85% of 20 patients with mediastinal lymph node metastases from lower esophageal tumors. Furthermore, metastases were confined to either lower mediastinal or perigastric lymph nodes in 92% of 12 patients with a single metastatic node from these tumors. However, in cases of mid-esophageal tumors, metastases to the cervical, mediastinal, and abdominal lymph nodes were found in 24%, 66%, and 54% of 50 patients with mid-esophageal tumors, respectively. Therefore, cervical lymphadenectomy and lower mediastinal and perigastric lymphadenectomies are essential in patients with upper and lower esophageal cancer, respectively. However, all of cervical, mediastinal, and abdominal lymphadenectomies are needed for cure in patients with mid-esophageal cancer.

Key words
potentially curable esophageal cancer, anatomic characteristics of lymph node metastasis, extent of radical lymphadenectomy

Reprint requests
Tadashi Nishimaki The First Department of Surgery, Niigata University School of Medicine 1-757 Asahimachi-dori, Niigata, 951-8510 JAPAN

Accepted
July 28, 1999

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