[A clinicopathological study on extensive lymph node dissection for thoracic esophageal cancer]

In order to evaluate clinical effect of the extensive lymph node dissection for thoracic esophageal cancer, 78 cases with esophagectomy and extensive lymph node dissection were reviewed. Pathological depth of invasion was the submucosa (sm: 25 cases), the proper muscle (pm: 7 cases), al (8 cases) and a2 (38 cases). Incidence of operative death rate in 30 days was 2.8% of all cases and hospital death rate 5.1%. Lymph node metastasis was identified in 65% of all cases (cervical metastasis occupied 19.2% of all cases with metastasis, mediastinal metastasis 48.7% and abdominal metastasis 34.6%). Over all cumulative three year survival rate was 55.3% (sm 88.9%, pm & al 55.6% and a2 40%). Postoperative recurrence was analyzed on thirty eight cases with more than three years passed after esophagectomy with extensive lymph node dissection. Postoperative recurrence was detected in 50% of all cases (local recurrence occupied 16% of all cases with recurrence, distant organ metastasis 58%, lymph node metastasis 21% and dissemination 5%). Extensive lymph node dissection significantly elongated disease free interval and survival time of cases with recurrence and lymph node metastasis, but there was no significant improvement in cases with other mode of recurrence. Dissecting field was classified into four regions (cervical, paratracheal, periesophageal and abdominal regions). Number of lymph nodes with metastasis and number of regions with lymph node metastasis showed close relationship with incidence of post operative recurrence. In cases with number of lymph node metastasis more than six and in more than two regions, all cases resulted in recurrence. Extensive lymph node dissection have an effect improving survival rate on cases with number of lymph node metastasis less than five and in less than two regions.