[Clinical evaluation of cervical and superior mediastinal lymph node dissection for intrathoracic esophageal...

From 1985 to 1989, 257 cases of carcinoma of the thoracic esophagus underwent esophagectomy and lymph node dissection with right thoracotomy based on preoperative staging. Bilateral cervical lymph node dissection was selected in cases in which preoperative examinations (CT, US, EUS, etc) revealed metastasis to cervical or superior mediastinal lymph nodes and cervical or superior mediastinal lymph nodes and in cases of tumors of the upper intrathoracic esophagus. All cases were classified into 3 groups according to region of lymph node dissection. In addition to dissection of the lymph node in the mediastinum and abdomen, group A (102 cases) underwent bilateral cervical and extensive superior mediastinal lymph node dissection (en bloc removal of tissue from the upper mediastinum), group B (61 cases) underwent extensive superior mediastinal lymph node dissection with or without left side cervical dissection and group C (94 cases) underwent standard dissection. Group A contained more advanced cases and cases with metastasis to the upper mediastinal lymph nodes compared to groups B and C. Postoperative complications were also more frequent in group A than groups B or C and were slightly more frequent in group C than group B. Recurrent nerve palsy was recognized in 21% of group A cases. Operative death (within 30 days) was highest in the group A (5.8%) particularly in the elderly group aged over 70 y or absolutely non-curatively resected cases, while in group C the operative mortality was 2.2%. Apart from absolutely non-curatively resected cases, there was no significant difference in the survival curves of the 3 groups, and there was no difference between group A and B cases with no cervical metastasis and group C cases. Also, this selection showed a favorable survival curve following esophagectomy in the period since 1985 compared to the earlier period (1980-1984), excluding absolutely non-curative cases and early stage cases (ep, mm cancer). The results suggest our evaluation methods and selection criteria were appropriate. All absolutely non-curatively resected cases had poor survival rates without significant difference among the 3 groups. In this category of cases, bilateral cervical lymph node dissection of absolutely non-curative cases was not effective. In cases with 1-3 metastatic lymph nodes of all, there was a significant difference in prognosis between group A and groups B and C, but there was no significant difference in cases with more than 4 metastatic lymph nodes. Those results suggest that when 1-3 lymph nodes are metastatic, it is necessary to dissect bilateral cervical lymph nodes.(ABSTRACT TRUNCATED AT 400 WORDS)