Patterns of lymph node metastasis in three-field dissection for thoracic esophageal carcinoma. Optimal extension of lymph node dissection.:OPTIMAL EXTENSION OF LYMPH NODE DISSECTION

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概要

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• The purpose of this retrospective study was to analyze the site and rate of lymph nodes metastases originating from thoracic esophageal carcinoma and also to confirm the optimal extension of lymph node dissection in the treatment of thoracic esophageal carcinoma. A total of 70 patients were included in this study. The rate of lymph node metastases was 61% with no difference in the location of tumors. The rates of lymph node metastases in the tumor depth of muscularis mucosae (mm) and submucosa (sm) were 17% and 60%, respectively. Tumors with mm<SUB>3</SUB> (massive invasion) depth had lymph node metastases of 29%, however, in cases of mm<SUB>1-2</SUB> (slightly or moderate invasion), no lymph node metastases occurred. The deeper the tumor invaded, the higher and wider was the occurrence of lymph node metastases. The rates of lymph node metastases in the cervical, thoracic, and abdominal nodes were 14%, 37%, and 43%, respectively. Lymph node metastases jumped to the cervical region without upper mediastinal node metastases even if the tumor was located in the lower esophagus or the depth of tumor was mm3. In the thoracic nodes, the rates of metastases to the paraesophageal, the paratracheal (which includes the region of the right and left recurrent laryngeal nerve), and the bifurcation nodes were a maximum of 21%, 17%, and 10%, respectively. In the abdominal nodes, the rate of metastases to the right cardiac nodes was the highest. Among patients who underwent radical lymph node dissection, lymph node metastasis was seen in the paraaortic nodes but not surrounding the splenic artery or in the splenic hilar nodes. Patients who underwent three-field lymph node dissection had relatively better survival compared to those with two-field lymph node dissection. The cumulative survival rate was 52.8% after 5 years. Based on this study, the optimal extension of lymph node dissection is as follows : when a tumor has invaded to the mm3, standard three-field dissection should be performed, including the cervical and thoracic paratracheal, the deep cervical, and the supraclavicular nodes. When a tumor has invaded layer deeper than mp, a three-field dissection including the bifurcation, the pulmonal hilar, the paratracheal (including left thoracobronchial and Botallo nodes) and the intraabdominal paraaortic nodes sparing the pancreas and spleen, should be performed.

• 北関東医学会の論文

著者

• Takeyoshi Izumi

  Second Department Of Surgery Gunma University School Of Medicine

• Koyama Toru

  Second Department Of Surgery Faculty Of Medicine Gunma University

• Ohwada Susumu

  Second Department Of Surgery Faculty Of Medicine Gunma University

• KAWATE SUSUMU

  Second Department of Surgery, Gunma University Faculty of Medicine

• KAWASHIMA YOSHIYUKI

  Second Department of Surgery, Gunma University Faculty of Medicine

• Morishita Yasuo

  Second Department Of Surgery

• OHWADA SUSUMU

  Second Department of Surgery, Gunma University School of Medicine

• Ogawa Tetsushi

  Second Department of Surgery, Gunma University Faculty of Medicine

• Ogawa Tetsushi

  Second Department of Surgery, Gunma University School of Medicine

• Kawashima Kenji

  Second Department of Surgery, Gunma University School of Medicine

• Ohya Toshihiro

  Second Department of Surgery, Gunma University School of Medicine

• Nakasone Yutaka

  Second Department of Surgery, Gunma University School of Medicine

• Kawashima Yoshiyuki

  Second Department of Surgery, Gunma University School of Medicine

• Kawate Susumu

  Second Department of Surgery, Gunma University School of Medicine

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