[Regional neck dissection in carcinoma of the cervical esophagus]

The metastatic spread in the neck of carcinoma of the cervical esophagus was studied in 10 patients from 1970 to 1985. The recurrent chain was involved in 6 patients: 2, unilateral and 4, bilateral. The metastatic nodes in each patients were counted 1, 2, 2, 2, 4 and 6, 17 in total. Their sizes ranged from 5 mm to 15 mm. However, they were not palpable preoperatively. Therefore, this area always should be dissected. The internal jugular chain including supraclavicular nodes had seven metastatic nodes in 6 patients; only one node, 3 cm in diameter, palpated preoperatively; 3 nodes, 2.5 cm, 6 mm and 5 mm, detected microscopically; and 3 nodes, 4 cm, 3 cm, a tip of small finger, palpated by clinical emergence in course of follow-up. Seven nodes distributed 0 in upper jugular, 3 in mid jugular (one node in the level of carotid bulbus was the highest one), 1 in lower jugular and 3 in supraclavicular. From this data the author feel that upper jugular nodes need not be dissected in the elective neck dissection for carcinoma of the cervical esophagus. The author recommend elective procedure for negative neck since 2 out of 4 patients developed positive nodes later in undissected necks, and 2 out of 4 patients revealed microscopically positive nodes in electively dissected necks. It is interesting that the rate of metastasis in jugular chain is high (5/6) in patients who have positive nodes in recurrent chain. There were two unusual sites of metastasis; one Delphian node in patient whose primary lesion invaded to thyroid gland, and pretracheal as well as upper mediastinal nodes in patient who had 6 positive nodes in recurrent chain and one positive node in jugular chain.