Lymph node dissection

Cervical lymph nodes are involved in 43% of patients with an upper esophageal lesion, 33% of patients with a middle third tumor, and 29% with a tumor of the lower third. Conventional two-field lymph node dissection removing the abdominal and lower mediastinal lymph node groups leads to inaccurate staging and is inadequate for preventing local recurrence. Three-field lymphadenectomy involves bilateral removal of the lower cervical groups of nodes, the superior, middle, and inferior mediastinal lymph nodes and the abdominal groups. The advantages of this extended dissection are improved survival, diminished incidence of local recurrence, and more accurate staging. The benefits in terms of improved survival may accurate to patients both with and without cervical lymph node involvement. Three-field node dissection improves 5-year survival to around 35% without an increase in the mortality rate. The incidence of recurrent laryngeal nerve paralysis is increased with the operation and could be as high as 14% or more.