Preoperative Assessment of Lymph Nodes on Selecting the Dissection Method for Cancer of the Thoracic Esophagus

Toshiki Matsubara, Sakae Okumura, Mamoru Ueda, Atsushi Ota, Mitsumasa Nishi

Department of Surgery, Cancer Institute Hospital

The preoperative assessment of the regional lymph nodes was correlated with the pathological findings and surgical results, in 198 patients with cancer of the thoracic esophagus undergoing esophagectomy. The nodal states were divided into 4 categories: (-), negative; (±), possible; (+), probable and (++), sure. 1. The sensitivity detecting positive nodes was limited because of frequent minute cancer deposite in lymph nodes. Involvement of lymph nodes along the recurrent nerves and perigastric lymph nodes was detected more sensitively than nodal involvement in the middle and lower mediastinum. Since the former lymph node groups are involved in earlier stages than the latter groups, limited resection without right thoracotomy can be regarded as a radical cure in poor risk cases which show no signs of cancer metastasis. 2. The specificity of nodal assessment was more than 95%, when (±) cases were regarded as negative. Such strict evaluation is useful for the selection of candidates for extended lymph node dissection. 3. The outcome after surgery was significantly less favorable when right recurrent nerve nodes or upper gastric nodes were (++). 4. The surgical outcome in cases which had lymph node involvement did not correlate with the preoperative evaluation, except for (++) cases.

Key words
lymph node assessment in cancer of the thoracic esophagus, esophageal neoplasm, dissection procedure for cancer of the thoracic esophagus

Reprint requests
Toshiki Matsubara Department of Surgery, Cancer Institute Hospital
1-37-1 Kami-Ikebukuro, Toshima-ku, Tokyo, 170 JAPAN

Accepted
November 20, 1991

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