[Pattern of lymphatic spreading in cancer of the thoracic esophagus--analysis in cases undergoing cervical...

The distribution of involved nodes was analyzed in 110 patients with cancer of the thoracic esophagus undergoing systematic dissection of lymph nodes including cervical nodes. Nodal involvement was found in 75% of cases. The distribution pattern of involved nodes suggested that the esophagus is directly drained by various lymph nodes. Cancer metastasis was commonly found across a considerable longitudinal distance; even across two thirds of the esophagus. Longitudinal metastasis to lymph nodes along the recurrent laryngeal nerves (RLNs): upward metastasis, or the perigastric nodes: downward metastasis, was quite frequent. Especially, the right RLN nodes and cardiac nodes were involved in 40% of cases, respectively. In cases with a solitary involved node or with superficial cancer, such upward or downward metastasis was much more prominent than other metastasis. Surgical results varied with the number of positive nodes and the involved site. Cases with no or one positive node showed similar late results; significantly better than the result in other cases (p less than 0.05). Most of three year survivors with nodal involvement had only upward and/or downward metastasis. Perigastric involvement had less influence on the result than mediastinal involvement. Though the pattern of lymphatic extension in esophageal cancer is apparently quite singular, it seemed to be derived from the fact that the esophagus is directly drained by many widely distributed lymphatic channels which have different clinical meanings.