Three-Field Lymph Node Dissection for Squamous Cell and Adenocarcinoma of the Esophagus

Abstract

ObjectiveTo determine the prevalence of occult cervical nodal metastases in patients with squamous cell cancer and adenocarcinoma of the esophagus, and to determine the impact of esophagectomy with three-field lymph node dissection on survival and recurrence rates. Summary Background DataAlthough esophagectomy with three-field lymph node dissection is commonly practiced in Japan, its role in the surgical management of esophageal cancer in the United States, especially in patients with esophageal adenocarcinoma, is essentially unknown. MethodsThis is a prospective observational study of esophagectomy with three-field lymphadenectomy. Eighty patients underwent resection between August 1994 and April 2001. Clinicopathological information and follow-up data were collected on all patients until death or June 2001. ResultsHospital mortality and morbidity rates were 5% and 46%, respectively. Metastases to the recurrent laryngeal and/or deep cervical nodes occurred in 36% of patients irrespective of cell type (adenocarcinoma 37%, squamous 34%) or location within the esophagus (lower third 32%, middle third 60%).Overall 5-year and disease-free survival rates were 51% and 46%, respectively. Sixty-nine percent presented with nodal metastases. The 5-year survival rate for node-negative patients was 88%; that for those with nodal metastases was 33%. The 5-year survival rate in patients with positive cervical nodes was 25% (squamous 40%, adenocarcinoma 15%). ConclusionsEsophagectomy with three-field lymph node dissection can be performed with a low mortality and reasonable morbidity. Unsuspected metastases to the recurrent laryngeal and/or cervical nodes are present in 36% of patients regardless of cell type or location within the esophagus. Thirty percent of patients were upstaged, mainly from stage III to stage IV. An overall 5-year survival rate of 51% suggests a true survival benefit beyond that achieved solely on the basis of stage migration.

Total Oesophagectomy for Squamous Cell Carcinoma With or Without Standard Two Field Node Dissection - A Prospective Study

“…Because of the extensive lymphatic network and rich mucosal and submucosallymphatics within the wall of the esophagus, skip metastases for upper third lesions have been noted in celiac axis nodal basins, and likewise, cervical lymph node metastases have been noted in as many as 30 % of patients with distal esophageal lesions. This forms the basis for some surgeons recommendation of a more thorough oncologic procedure, a combined transthoracic and abdominal approach for lesions of the middle and distal esophagus [7,8], and for others recommendation of a three-field (cervical,mediastinal, and abdominal) lymphadenectomy for all tumors of the middle through distal esophagus [2,4]. However, lymphatic spread correlates with pathologic T category of the primary esophageal tumor, and lymph node metastases are initially limited in an overwhelming majority of patients to regional lymph nodes.…”

“…Surgeons in the West, in part influenced by a more minimalistic attitude, have been sceptical and reluctant to adopt the procedure because in North America and Europe most cancers occur in the distal esophagus and GEJ and because of fear for increased mortality and morbidity when adding a bilateral cervical lymphadenectomy. Data from Western experience with 3-field lymphadenectomy are therefore scarce and dealing with relatively small numbers [4]. Hence standard 2 field lymphadenectomy is the surgical treatment of choice for localised squamous cell carcinoma of mid and lower esophagus.…”

Histone Deacetylase Inhibitor FK228 Activates Tumor Suppressor Prdx1 with Apoptosis Induction in Esophageal Cancer Cells

“…Recently, applications of combined chemotherapy and radiotherapy, or the combination therapy as an adjunct to surgery, have improved the prognosis of esophageal squamous cell carcinoma patients (3,4). Thus, there is some urgency for the development of new antitumor agents so as to further improve the prognosis of esophageal squamous cell carcinoma patients.…”

Accuracy of ultrasound for the diagnosis of cervical lymph node metastasis in esophageal cancer: a systematic review and meta-analysis

“…With a pretest probability of 20%, the post-test probability of CLN, given positive and negative ultrasound results, were 80% and 3%. (43,44). In the 7 th edition of the esophageal AJCC (American Joint Committee on Cancer) staging guidelines, a regional LN has been redefined to include any paraesophageal node extending from the cervical nodes to the celiac nodes (45).…”