Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2002 Aug;236(2):177-83.
doi: 10.1097/00000658-200208000-00005.

Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus

Nasser Altorki  1 , Michael Kent, Cathy Ferrara, Jeffrey Port
Affiliations

Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus

Nasser Altorki et al. Ann Surg. 2002 Aug.

Abstract

Objective: To 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 data: Although 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.

Methods: This 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.

Results: Hospital 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%).

Conclusions: Esophagectomy 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.

PubMed Disclaimer

Figures

None
Figure 1. Overall and disease-free 5-year survival.
None
Figure 2. Survival by stage.
None
Figure 3. Survival by N-status.
None
Figure 4. Survival by cervicothoracic nodal status in node-positive patients.
None
Figure 5. Positive cervicothoracic nodes: survival by cell type.
See this image and copyright information in PMC

References

    1. Tanabe G, Nishi M, Kajis T, et al. Analysis of lymph node metastases and surgical treatments for thoracic esophageal cancer: New method of the initial dissection of the cervix and abdomen. Jpn J Gastroenterol Surg 1983; 16: 1890–1896.
    1. Kato H, Tachimori Y, Watanabe H, et al. Lymph node metastases in thoracic esophageal carcinoma. J Surg Oncol 1991; 48: 106–111. - PubMed
    1. Isono K, Onoda S, Nakayama K, et al. Recurrence of intrathoracic esophageal cancer. Jpn J Clinical Oncol 1985; 15: 49–60. - PubMed
    1. Isono K, Sato H, Nakayama K. Results of a nationwide study on three-field lymph node dissection of esophageal cancer. Oncology 1991; 48: 411–420. - PubMed
    1. Orringer MB. Occult cervical nodal metastases in esophageal cancer: Preliminary results of three-field lymphadenectomy [editorial]. J Thorac Cardiovasc Surg 1997; 113: 538–539. - PubMed

MeSH terms