A Study on the Optimal Lymph Node dissection for Thoracic Esophageal Carcinoma according to the Stage

Tomoko Hanashi and Misao Yoshida

Department of Surgery, Tokyo Metropolital Komagome General Hospital

The optimal lymph node dissection for thoracic esophageal carcinoma according to stage of the disease was studied. Thirty-four cases of m3 & sm1 cancer, treated by endscopic mucosal resection followed by radiotherapy or chemoradiotherapy in 67% of all cases, achieved good 5-years survival rates equal to surgical treatment. One hundred cases with sm2∼a2 esophageal cancer underwent a curative operation with 3-field lymph node dissection (3FD) without neoadjuvant therapy. 68 cases with positive lymph nodes of less than 3, achieved good 5-year survival rate, and no lymph node recurrence. They should undergo a curative operation with 3FD. In 28 cases with 4∼9 positive lymph nodes, or with severe microvascular invasion, distant organ metastasis was not decreased. These patients need multimodal therapy including a curative operation. In 29 cases with tumor at the lower half of Lt, and without lymph node metastasis in the neck and the upper mediastinum, the patients underwent lower esophageal and gastric resection through left-thoracothomy with lymph node dissection of the upper abdomen, and no lymph node recurrence was seen. So, in these cases, operations through left-thoracothomy and laparotomy are curative resections in superficial cancers, and are effective as a part of multimodal therapy for advanced cancers.

Key words
optimal dissection, 3-field dissection, esophageal cancer

Reprint requests
Tomoko Hanashi Department of Surgery, Tokyo Metropolitan Komagome General Hospital 3-18-11 Honkomagome, Bunkyo-ku, Tokyo, 113-8677 JAPAN

Accepted
July 28, 1999

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