Strategic lymph node dissection for thoracic and abdominal esophageal carcinoma in relation to nodal metastasis and location of carcinoma--analysis of subgroups carcinoma location]

The range of lymph node dissection in 226 cases of thoracic and abdominal esophageal carcinoma was investigated with reference to the relation between nodal metastasis and location of carcinoma. Subgroups of Iu (the upper third), Im (the middle third) and E (the lower third of thoracic esophagus plus abdominal esophagus) were defined as localized Iu (n = 10) and IuIm (n = 7); ImIu (n = 21), localized Im (n = 66), ImE (n = 34) and extensive Im (n = 6); and EIm (n = 23) and localized E (n = 59). In cases of Iu, dissection of cervical and upper mediastinal nodes including subaortic nodes was important, because of the high incidence of metastasis to right recurrent nerve nodes and left paratracheal nodes. Dissection of middle mediastinal nodes was also necessary in the IuIm group. Nodal metastases in cases of Im covered in a wide range, but there were some differences in distribution of nodal involvement in the three subgroups. Cervical and upper mediastinal (including subaortic) nodes in the ImIu group, upper mediastinal (excluding subaortic) nodes in the localized Im group and celiac-axis nodes in ImE group were found to have a high incidence of metastasis, while right recurrent nerve nodes and middle and lower mediastinal and upper gastric nodes commonly showed a high metastatic rate in all subgroups. Dissection was found to be essential for this range of lymph nodes, especially, for right recurrent nerve nodes and upper gastric nodes regarded as being affected by metastasis at the early stage.(ABSTRACT TRUNCATED AT 250 WORDS)