Appropriate Lymphadenectomy in Cases of Thoracic Esophageal Cancer : from the Aspects of Individualization and Step-up.
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Thoracic esophageal cancer has the potential risk of lymph node metastasis to any ofthe three fields of the neck, mediastinum, and/or abdomen. Therefore, an esophagectomy with three-field lymphadenectomy has been recommended in patients with cancer invading deeper than the deep mucosal (M3) layer. In this study 732 patients with thoracic esophageal cancer, between 1985 and 1997, were included. The rate of 5-year survival was compared between the groups of three-field and two-field (mediastinum and abdomen) nodal dissection. Patients who underwent partial neck dissection were included into the group of two-field dissection. In addition, 243 cases of superficial esophageal cancer were examined regarding recurrence in the neck region. The overall 5-year survival rate in the groups of three-field and two-field dissection were 28.8% and 47.9%, respectively. However, the background of the two groups was essentially different. In the superficial cancer cases, out of 50 patients after 3-field dissection a recurrence occurred in 8 (16.0%), and in 21 cases (10.9%) out of 193 patients after 2-field dissection. The neck recurrence contributed as a fatal factor in only one patient after 2-field dissection. Although neck dissection was valuable the local control of cancer, the recurrence in the mediastinum, abdomen, and distant organs was more influential on the mortality than the recurrence in cervical region becausethe metastatic cervical node (s) were usually resectable. Nowadays, we can predict the possibility of cervical node metastasis by applying many modalities and clinicopathological information. We think that the value of prophylactic neck dissection is not high in patients with clinically negative nodes in the neck region, and we can decide on the indication of prophylactic neck dissection individually in each patientwith thoracic esophageal cancer.
- 一般社団法人 日本消化器外科学会の論文
一般社団法人 日本消化器外科学会 | 論文
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