[Characteristics of lymph node metastasis in thoracic esophageal carcinoma]

To investigate the frequency, distribution, and feature of lymph node metastasis in thoracic esophageal carcinoma, and to provide evidence for lymph node dissection and the multidisciplinary therapy for patients with esophageal carcinoma postoperatively.

The clinical data of 623 patients with thoracic esophageal carcinoma who had undergone esophagectomy plus lymph node dissection were studied to analyze the characteristics of lymph node metastasis.

Totally 3689 of lymph node groups (with 8603 nodes) were dissected. The lymph node metastasis rate was 47.2% and lymph node metastasis ratio was 10.3%. No lymph node metastasis was found in the patients of Tis stage, while lymph node metastasis was found in the patients of other stages. There were significantly differences in lymph node metastasis rate and ratio among the patients of different T stages (chi2 = 38.407, P = 0.00, and chi2 = 118.438, P = 0.000). The higher the T stage, the higher the lymph node metastasis rate and ratio (r = 1, P = 0.000, and r = 1, P = 0.000). Different pathological types of esophageal carcinoma had different lymph node metastasis ratio (chi2 = 84.577, P = 0.000), however, there was no significant difference in lymph node metastasis rate among different pathological types (chi2 = 6.284, P = 0.179). The patients with squamous carcinoma had the lowest lymph node metastasis ratio and lymph node metastasis rate. The lymph node metastasis was mainly regional and extended vertically in both directions. Leaping over metastasis was another feature. All segments of thoracic esophageal carcinoma, especially lower thoracic esophageal carcinoma, could metastasize to the celiac lymph nodes.

Lymph node dissection should be carried out properly in treatment of esophageal carcinoma and regional celiac lymph nodes should be explored and dissected more cautiously. Because surgical treatment is relatively radical in treatment of esophageal carcinoma, and taking the trend of lymph node metastasis and other indication into account, rational multidisciplinary therapy conducted as soon as possible should be adopted in the treatment of esophageal carcinoma.