[Extensive lymphadenectomy in thoracic esophageal carcinoma]

The operative results of an extensive lymphadenectomy for thoracic esophageal carcinoma were presented in this paper. PATIENTS AND METHODS. One hundred and forty-seven patients with thoracic esophageal carcinoma were operated on for 7 years from 1979 to 1986. Nineteen of 147 underwent extensive lymphadenectomy while the others underwent the conventional lymphadenectomy. In the conventional lymphadenectomy, paraesophageal nodes and right paratracheal nodes were dissected in the upper upper mediastinum and cervical nodes were not dissected; on the other hand, in the extensive lymphadenectomy, paraesophageal nodes, bilateral paratracheal and tracheobronchial nodes, pretracheal nodes and anterior mediastinal nodes were removed, as well as bilateral deep cervical and supraclavicular nodes. There was no difference in lymph node dissection in the inferior mediastinum and the abdomen between the 2 groups. RESULTS. There was no difference in stage distribution between the 2 groups. There was no operation death in either group. The survival rate of the conventional lymphadenectomy group was 50% at 1 year, 28.8% at 3 years and 24.9% at 5 year; on the other hand, that of the extensive lymphadenectomy group was 73.7% at 1 year, 52.6% at 3 years and 46.8% at 5 years. There were no differences in blood loss and the incidence of anastomotic leakage between the 2 groups, but, the incidence of postoperative pulmonary complication and temporary recurrent laryngeal nerve palsy was higher in the extensive lymphadenectomy group. CONCLUSION. The results suggest that extensive lymphadenectomy improves the survival rate after operation for patients with thoracic esophageal carcinoma. At present, this procedure should be applied for selected patients with good general condition because of the greater surgical stress.