Appropriate Lymphadenectomy in Cases of Thoracic Esophageal Cancer: from the Aspects of Individualization and Step-up

Tatsuyuki Kawano, Kagami Nagai, Haruhiro Inoue, Yohsuke Izumi, Masanori Nakamura, Satoshi Nara, Yohichi Kumagai, Yasuaki Nakajima, Kunihide Yoshino and Takehisa Iwai

First Department of Surgery, Tokyo Medical and Dental University School of Medicine

Thoracic esophageal cancer has the potential risk of lymph node metastasis to any of the three fields of the neck, mediastinum, and/or abdomen. Therefore, an esophagectomy with three-field lymphadenectomy has been recommended in patients with cancer invading deeper than the deep mucosal (M3) layer. In this study 732 patients with thoracic esophageal cancer, between 1985 and 1997, were included. The rate of 5-year survival was compared between the groups of three-field and two-field (mediastinum and abdomen) nodal dissection. Patients who underwent partial neck dissection were included into the group of two-field dissection. In addition, 243 cases of superficial esophageal cancer were examined regarding recurrence in the neck region. The overall 5 year-survival rate in the groups of three-field and two-field dissection were 28.8% and 47.9%, respectively. However, the background of the two groups was essentially different. In the superficial cancer cases, out of 50 patients after 3-field dissection a recurrence occurred in 8 (16.0%), and in 21 cases (10.9%) out of 193 patients after 2-field dissection. The neck recurrence contributed as a fatal factor in only one patient after 2-field dissection. Although neck dissection was valuable the local control of cancer, the recurrence in the mediastinum, abdomen, and distant organs was more influential on the mortality than the recurrence in cervical region because the metastatic cervical node (s) were usually resectable. Nowadays, we can predict the possibility of cervical node metastasis by applying many modalities and clinicopathological information. We think that the value of prophylactic neck dissection is not high in patients with clinically negative nodes in the neck region, and we can decide on the indication of prophylactic neck dissection individually in each patient with thoracic esophageal cancer.

Key words
thoracic esophageal cancer, lymphadenectomy, individualization and step-up

Reprint requests
Tatsuyuki Kawano First Department of Surgery, Tokyo Medical and Dental University School of Medicine 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519 JAPAN

Accepted
July 28, 1999

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