Appropriate Range of Lymph Node Dissection for Carcinoma of the Thoracic Esophagus -Is Cervical Dissection Unnecessary for Carcinoma of the Lower Thoracic Esophagus?-

Mamoru Ueda, Toshiki Matsubara, Toyokazu Akimori, Tetsuya Abe and Takashi Takahashi

Department of Surgery, Cancer Institute Hospital

To assess the role of cervical dissection for lower esophageal cancer, we investigated 31 patients with intrathoracic tumor which did not invade the middle or upper third of the esophagus. The cervical node group was defined as lower deep cervical nodes and recurrent nerve nodes that were accessible through a cervical approach. The cervical group was involved in six (19%), and most of cervical involvement was found in the recurrent nerve nodes. Of six patients with cervical involvement, four had no involved nodes in other regions. Such involvement limited to the cervical region was found in two of 11 patients with superficial cancer. Recurrent neurve palsy developed postoperatively in four patients (13%), but hoarseness resolved within 6 months in all cases. Patients with involvement limited to the neck presented a favourable outcome. Cancer recurrence in the cervical region was found only in a patient who developed recurrence in the deep cervical nodes which were excluded from dissection at the cervical procedure. Even in the cancer of the lower third of the thoracic esophagus, cervical dissection is strongly recommended.

Key words
esophagectomy for carcinoma of lower thoracic esophagus, lymph node dissection through cervicotomy

Reprint requests
Mamoru Ueda Department of Surgery, Cancer Institute Hospital 1-37-1 Kami-Ikebukuro, Toshima-ku, Tokyo, 170-8455 JAPAN

Accepted
July 28, 1999

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