Cervical, mediastinal, and abdominal lymph node dissection (three-field dissection) for superficial carcinoma of the thoracic esophagus

Abstract

Background: The recent increase in the number of esophageal carcinomas detected at an early stage has prompted debate about the most suitable treatment for them.

Methods: Forty-three patients with superficial esophageal carcinoma (SEC) underwent esophagectomy with cervical, mediastinal, and abdominal lymph node dissection (three-field dissection). On the basis of the pathologic data and results of surgery, the adequacy of treatment was discussed.

Results: Three patients with pTis tumor had no positive lymph nodes. Twenty patients (46.5%) had positive nodes in the resected specimen. Nineteen lesions (57.6% of submucosal cancers) with lymph node metastasis had invasion to the submucosa. Five patients with submucosal cancer (15.2% of submucosal cancers) had positive nodes in the neck. The lymph nodes along the right recurrent nerve and the right paracardiac nodes were the most frequent site of metastasis (16.3%), whereas the right paratracheal, infracarinal, infra-aortic arch, common hepatic, and celiac nodes had no metastasis. The operative mortality rate was 2.3%. Recurrent disease occurred in three patients with submucosal cancer. The 5-year survival rate after surgery was 73.2% for all 43 patients and 68.6% for patients with positive nodes.

Conclusions: Esophagectomy with three-field lymph node dissection is recommended for patients with lesions diagnosed as submucosal cancer. Endoscopic mucosectomy is applicable as a first-choice treatment for patients with esophageal carcinoma at Tis.