Indication of Cervical and Abdominal Para-Aortic Lymph Node Dissection in Esophageal Cancer Patients from the Viewpoint of Micrometastasis

Yutaka Shimada, Fumiaki Sato, Go Watanabe, Seiji Yamasaki, Masayuki Kato, Masato Kano, Jun-ichi Kaganoi and Masayuki Imamura

Department of Surgery & Surgical Basic Science, Graduate School of Medicine, Kyoto University

For determination of the indication of cervical lymph node (LN) and abdominal para-aortic LN dissection in esophageal cancer patients, we examined micromatastasis in LN with immunohistochemical (IHC) staining of cytokeratin (AE1/AE3) and RT-nested PCR for SCC antigen mRNA. Among 109 (3977 LNs) esophageal cancer patients, 80 cases received 2 fields (including left cervical LN dissection) and 29 cases received 3 fields dissection. Eighteen micrometastasis and 75 micrometastasis were newly detected in 1145 LNs (pN0, 48 cases) and in 2832 LNs (pN1, 61 cases) with IHC respectively. As a result, 11 cases were newly diagnosed as positive of lymph node metastasis. With RT-nested PCR detected more large number of LN metastases (10.6%, 59/557) were detected than with IHC (8.6%, 48/557) and HE (6.5%, 36/557). Among 12 cases of cervical LN metastasis, 6 cases (50%) had positive LN in upper mediastinal LN (#106), whereas among 89 cases of negative cervical LN metastasis, 23 cases (25.8%, 23/89) had positive LN in upper mediastinal LN. With regard to para-aortic LN metastasis (#lt-16a1 and #lt-16a2), all 10 recurret cases had metastasis (including micrometastasis) in perigastiric lymph node (#1, 2, 3, or 7) . Furthermore, two recent cases of lower thoracic esophageal carcinoma with para-aortic LN dissection showed that both cases have micrometastasis in dissected para-aortic LN and one has survived 3 years after esophagectomy and the other has survived 5 months. These results indicated that the cases of upper mediastinal LN metastasis in thoracic esophageal cancer patients should receive cervical LN dissection and the cases of perigastric LN metastasis in lower thoracic esophageal cancer patients should receive para-aortic LN dissection. Further examination is required due to the small number of cases and short periods of follow-up.

Key words
esophageal cancer, micrometastasis, lymph node dissection

Reprint requests
Yutaka Shimada Department of Surgery and Surgical Basic Science, Graduate School of Medicine, Kyoto University 54 Shogoin-kawaracho, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
July 28, 1999

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