Indications and Limitations of 3-Field Lymph Node Dissection for Thoracic Esophageal Carcinoma

Miwako Arima, Yoshio Koide, Shinichi Okazumi, Hideaki Shimada, Hisahiro Matsubara,
Yukimasa Miyazawa, Yutaka Funami and Takenori Ochiai

Second Department of Surgery, Chiba University, School of Medicine

This study investigated indications and limitations of 3-field lymph node dissection in thoracic esophageal carcinoma. The subjects were 446 patients who underwent resection including EMR. There were 61 cases of Ut, 268 cases of Mt and 117 cases of Lt. Fifty-five patients showing pEP or pLPM as the depth of the lesion did not develop any lymph node metastasis or recurrence, and were considered indications for EMR or blunt dissection. Lymph node metastasis and recurrence were extremely rare in the abdomen in cases of Ut/pMM to SM, and in the neck in cases of Lt/pMM to SM, and therefore, it seemed that dissecion could be omitted. In patients showing Adj, curability C, 3-field lymph node metastasis of 5 or more metastatic lesions showed a very poor prognosis, and were classified as the poor-prognosis group (F group). Other patients were categorized as the A group. In the F group, the recurrece rate was 90% or more, and 3-year survival without recurrence was noted in 2 patients undergoing 3-field dissection, but not in any in patients undergoing 2-field dissection. In the A group, the recurrence rate was approximately 30%, and the 3-year survival rate without recurrence ranged from 40 to 50%. Three-field dissecion achieved significant improvement in prognosis compaired with 2-field dissection in cases showing pMP to Ad and Ut, Mt/pSM to Ad in the A group. In the F group, 3-year survival without recurrence was not observed in any patients undergoing 3-field dissection alone, but the prognosis was prolonged in patients receiving additional postoperative treatment. It is considered necessary to aggressively administer chemo-radiotherapy to patients in the F group.

Key words
esophageal carcinoma, 3-field lymph node dissection

Reprint requests
Miwako Arima Second Department of Surgery, Chiba University, School of Medicine 1-8-1 Inohana, Chuou-ku, Chiba City, 260-8677 JAPAN

Accepted
July 28, 1999

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