Long-Term Results of Subtotal Esophagectomy with Three-Field Lymphadenectomy for Carcinoma of the Thoracic Esophagus

Abstract

ObjectiveThis study evaluated the impact of aggressive surgery on survival in patients with carcinoma of the thoracic esophagus. Summary Background DataPrognostic value of lymph-node status for patients with esophageal carcinoma was emphasized, although it is currently under debate whether extensive lymph node dissection improves survival. MethodsTwo hundred ninety-five patients with thoracic esophageal carcinoma were admitted to Kagoshima University Hospital from December 1982 to December 1990. Esophagectomy was performed on 244 (82.7%) of these patients; 106 of whom underwent three-field lymphadenectomy (bilateral cervical, mediastinal, and abdominal regions) were analyzed regarding lymph-node status, tumor recurrence, and the effect of prognostic factors on survival using Cox's proportional hazards model. ResultsHospital mortality and morbidity were 10.4% (11/106) and 65.1%, respectively. Seventy-eight patients (73.6%) had nodal involvement, including 49 patients with abdominal lymph-node metastases and 46 patients with recurrent nerve-node metastases. Five-year survival rates were 54.5% for 16 patients with a solitary nodal metastasis, 30.3% for stage III, 17.4% for stage IV, and 7.2% for 28 patients with six or more metastatic nodes. The most frequent sites of recurrence were the upper mediastinal region and the lung -its incidence increased significantly as the number of positive nodes increased. The most unfavorable prognostic factors included regional or recurrent nerve-node metastasis and patient age of more than 71 years. ConclusionsThree-field lymphadenectomy, including especially the removal of bilateral recurrent nerve nodes in the cervical region, is essential for improving the survival of patients with carcinoma of the upper two thirds of the thoracic esophagus. 310

Recurrent laryngeal nerve injury after esophagectomy for esophageal cancer: incidence, management, and impact on short- and long-term outcomes

“…For 6/21 of these patients surgical intervention (medialization thyroplasty) was required. All treatment interventions for vocal cord paralysis were conducted after a median time of 16.5 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] months after esophagectomy. Of all patients that underwent medialization thyreoplasty, 3/6 had no more RLNP symptoms afterwards 2/6 made a partial recovery from their RLNP, and 1/6 did not recover.…”

“…The incidence of RLNP after esophagectomy varies, ranging from 0% to 59% (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These disparities have been attributed to variation in extent of lymph node dissection, surgical technique (two-or three stage), the size and T-stage of the primary tumor, and the means of RLN injury diagnosis (8,(19)(20)(21).…”

Esophagectomy for esophageal carcinoma - surgical complications and treatment

“…In a sample of 432 patients in stages I-IV according to the UICC classification who had undergone transthoracic or transhiatal resection of the esophagus, Siewert reports pulmonary complications (pneumonia or ARDS) in 22.9%. Baba refers to pulmonary complications in 23.6% of patients after a three-cavity dissection of the esophagus 8,9 . In the literature, no significant difference in pulmonary complications has been described between the transthoracic and tranhiatal approach for esophageal resection 8,10 .…”

Correlations between Extranodal Metastasis and Prognosis in Patients with Squamous Cell Carcinoma of the Esophagus

“…However, the spread of cancer cells to extracapsular connective tissues surrounding the lymph nodes, called extranodal metastasis EM [1][2][3] , is also often found during detailed histological investigations of resected lymph nodes in squamous cell carcinoma of the esophagus. EM has also been reported in carcinomas of the stomach [4][5][6][7] , rectum 8,9 , thyroid 10,11 , breast 12,13 , vulva 14 , and lung 15,16 , and such metastasis has been linked to the rate of disease progression.…”