Rational Extent of Dissection in Esophagectomy for Thoracic Esophageal Cancer According to Location of the Tumor and Depth of the Tumor Infiltration

Reiki Eguchi, Hiroko Ide, Tutomu Nakamura, Kazuhiko Hayashi and Ken Takasaki

Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University

To define the rational extent of dissection for esophageal cancer clinicopathological study was carried out on 734 patients who underwent esophagectomy. The survival curve of patients who received cervical lymphadenectomy was better than that of patients who didn't, on conditions that the tumor locating in middle third of the thoracic esophagus (Im), with lymph node metastasis and without upper mediastinal lymph node metastasis. So cervical lymphadenectomy must be not available for patients with many lymph node metastasis in upper mediastinal. The extended upper mediastinal lymphadenectomy improved survival of the patients. The cervical lymphadenectomy should be performed in patients with carcinoma of upper third of the thoracic esophagus (Iu). Lymphadenectomy around common hepatic artery and celiac axis is not necessary for patients with carcinoma infiltrating within muscularis propria or reaching the adventitia (a1) of Iu. The cervical lymphadenectomy is recommended in patients with carcinoma invading to adventitia (a2) or adjacent structures (a3) of Im. But the dissection is not necessary for patients with carcinoma invading limited to the middle strata of the submucosal layer (sm2) of Im. And only inner side cervical lymphadenectomy should be performed for patients with carcinoma invading to the lower strata of the submucosal layer (sm3) of Im. Lymphadenectomy around common hepatic artery is not necessary in patients with superficial carcinoma of Im. The cervical lymphadenectomy must be required in patients with carcinoma infiltrating between sm3 and a1 of lower third of the thoracic esophagus (Ei), and the upper mediastinal lymphadenectomy isn't necessary for patients with carcinoma of lower part of Ei or with carcinoma infiltrating limited within sm2 of Ei.

Key words
rational extent of lymphadenectomy for esophageal cancer, three-fields lymph node dissection for esophageal cancer, lymph node metastasis according to cancer location and invading depth

Reprint requests
Reiki Eguchi Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University 8-1 Kawada-cho, Shinjukuku, Tokyo, 162-8666 JAPAN

Accepted
July 28, 1999

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