Results of 3-field Lymph Node Dissection for Esophageal Cancer by Depth of Invasion and State of Lymphatic Metastasis

Harushi Osugi, Masayuki Higashino, Taigou Tokuhara, Nobuyasu Takada, Yoshihiko Nishimura, Masashi Takemura, Takanobu Funai and Hiroaki Kinoshita

Second Dept. of Surgery, Osaka City University, Medical School

The effect of extended lymphadenectomy was studied in 225 patients with thoracic esophageal cancer by depth of invasion and state of lymphatic metastasis. In the patients with the lesion of T1b or deeper, metastasis was found in the neck, mediastinum and abdomen, except celiac nodes or nodes required cervical approach to be dissected in patients with the lesion in Ut or Lt, respectively. Outcome was more closely related with lymphatic metastasis than depth of invasion. Curative surgery for the patients with T4 lesion should be indicated when lymphatic metastasis is minor. Because of high incidence of metastasis to the recurrent laryngeal nerve nodes, complete dissection of nodes at cervico-thoracic border, regardless to location of the esophageal lesion, is essential to obtain good outcome. Many of the patients with metastasis to the nodes required cervical approach to be dissected or celiac nodes still have been at a stage of lymphatic dissemination and have little benefit for the lymphadenectomy. However the dissection including these nodes is recommended to obtain free surgical margin in dissection for these nodes with high incidence of metastasis and proper staging for indicating combined treatment except for the patients with an apparent metastasis to these nodes, because the precise diagnosis of lymphatic metastasis is still difficult.

Key words
3-field lymph node dissection for esophageal cancer, lymphatic metastasis of esophageal cancer, diagnosis of lymphatic metastasis

Reprint requests
Harushi Osugi Second Department of Surgery, Osaka City University Medical School 1-4-3 Asahimachi, Abenoku, Osaka, 545-8586 JAPAN

Accepted
July 28, 1999

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