[Systematic lymphadenectomy in esophageal carcinoma--preliminary results of a prospective randomized study]

The influence of transhiatal blunt esophagectomy with dissection of all reachable lymph nodes (ESD) and en-bloc-esophagectomy (EB) on perioperative cardio-pulmonary stress and late results was analysed in a prospective randomized trial. Blunt dissection of the esophagus was performed without systematic lymph node dissection (SD) in patients with increased cardio-pulmonary dysfunctions. Until now 26 patients (ESD: 13, EB: 13) entered the study as well as 14 patients treated by blunt dissection. The number of dissected lymph nodes in each patient was 7.5 (SD), 19.9 (ESD) and 37.6 (EB). Ratio of invaded to removed lymph nodes was 0.26 (SD), 0.25 (ESD) and 0.1 (EB). The 30-day mortality rate was 8.0% in each group. Under the consideration of this mortality, one-year survival rate was 79% (SD), 70% (ESD) and 77% (EB). Patients with negative lymph node involvement showed a one-year survival of 85% and positive involvement lead to a survival rate of 70% after one year, independently of the surgical approach.