Surgery of squamous cell carcinoma of the esophagus

Identification of prognostic factors which may influence survival in patients with squamous cell carcinoma of the esophagus is critical for the selection of those patients who benefit from a surgical resection and the choice of the radicality of the procedure. We evaluated the tumor characteristics which independently influenced survival in 249 consecutive patients with squamous cell carcinoma of the esophagus who had undergone en bloc resection and 2-field lymphadenectomy. Multivariate analysis in the entire patient population identified (1) the pT category, (2) the pN category, (3) more than 7 positive mediastinal lymph nodes, and (4) the presence of residual tumor after resection, i.e. a R1 or R2 resection, as the only independent factors influencing survival time. In a second multivariate analysis of 94 patients who survived the procedure for at least 30 days, who had a R0 resection, and who did not have preoperative neoadjuvant therapy, only the pN-category, the presence of more than 7 positive mediastinal lymph nodes, and the ratio between positive and removed mediastinal lymph nodes independently influenced survival. These data suggest that only a R0 resection, i.e. complete macroscopic and microscopic tumor removal, can increase survival in patients with squamous cell carcinoma of the esophagus. In patients with a limited number of positive mediastinal lymph nodes the prognosis may be improved by a 2-field lymphadenectomy, if the number of removed mediastinal lymph nodes exceeds the number of positive nodes by a factor of at least 5.