Significance of Lymph Node Dissection of Neck and Upper Mediastinum according to Metastatic Analysis of 3-Field Dissection for Cancer of the Thoracic Esophagus

Hideo Shimada, Osamu Chino, Hikaru Tanaka, Gen Oshiba, Takayoshi Kise, Nobuharu Himeno, Takahiro Kenmochi, Takao Machimura, Tomoo Tajima and Hiroyasu Makuuchi

Department of Surgery, Tokai University, School of Medicine

We evaluated the significance of lymph node dissection of neck and upper mudiastinum and prognosis according to the number of metastatic lymph node. Two hundred twenty-five cases of thoracic esophageal cancer patients underwent three-field dissection from 1986 to 1997. The rate of lymph node metastasis was 66.7%, while the rate of neck lymph node metastasis was 17.3%. The mode of lymph node metastasis depend on the region occupied by the tumor, but the metastasis is found throughout in these three field, and was noted to the upper mediastinum, around recurrent nerve and further to the neck as the first lymph node metastasis. The prognosis was not correlated with the existence of neck lymph, but the number of lymph node more than four produced poor prognosis. The superficial esophageal cancer extending beyond sm2, regarded as having frequent lymph node metastasis, and the advanced cancer had the possibility to have neck lymph node measasis. Thereby the systemic three lymph node dissection was found necessary for these cases at this moment, when the preoperative diagnosis of lymph node metastasis is still uneasy.

Key words
thoracic esophageal cancer, three field dissetion, survival rate

Reprint requests
Hideo Shimada Department of Surgery, Tokai University, School of Medicine Boseidai, Isehara, 259-1193 JAPAN

Accepted
July 28, 1999

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