Skip to main content

Advertisement

SpringerLink
Log in

The history of lymphadenectomy for esophageal cancer and the future prospects for esophageal cancer surgery

  • Review Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

I would herein like to look back upon surgery for esophageal cancer, particularly on lymphadenectomy, and to speculate a little on the future prospects for esophageal surgery. There are two schools of thought on lymphadenectomy in esophageal cancer: one believes in en bloc esophagectomy, which is commonly performed in Western countries; the other believes in three-field lymphadenectomy, which is commonly performed in Japan. We esophageal surgeons at Kurume University have contributed to some advances in three-field lymphadenectomy. For example, we initiated functional mediastinal dissection to ensure patient safety, and we proposed the lymph node compartment theory to assess the clinical importance of regional nodes. Oncological surgery has progressed in terms of its safety, radicality and functional preservation, leading to improved quality-of-life for patients after surgery. This then evolved to the current development of multimodal and individualized tailor-made treatments. I believe that surgery for esophageal cancer will become bipolarized in the future. One strand will evolve as salvage surgery for residual or recurrent tumors, which non-surgical therapies have failed to cure, and the other strand will evolve as less invasive surgery, adjuvant surgery, for cancers at the relatively early stage, for which micro-metastasis can be cured by non-surgical therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Scannel JG. Historical perspectives Samuel J. Meltzer (1851–1920). J Thorac Cardiovasc Surg. 1996;111:905–6.

    Article  Google Scholar 

  2. Torek F. The first successful case of resection of the thoracic portion of the oesophagus for carcinoma. Surg Gynecol Obstet. 1913;16:614–7.

    Google Scholar 

  3. Lewis I. The surgical treatment of carcinoma of the oesophagus with special reference to a new operation for growths of the middle third. Br J Surg. 1946;34:18–31.

    Article  CAS  PubMed  Google Scholar 

  4. Logan A. The surgical treatment of carcinoma of the esophagus and cardia. J Thorac Cardiovasc Surg. 1963;46:150–61.

    CAS  PubMed  Google Scholar 

  5. Skinner DB. En bloc resection for neoplasms of the esophagus and cardia. J Thorac Cardiovasc Surg. 1983;85:59–71.

    CAS  PubMed  Google Scholar 

  6. Siewert JR, Hölscher AH. Eingriffe beim Ösophaguskarzinom. In: Siewert JR, editor. Breitner Chirurgische Operationslehre Band IV, Chirurgie des Abdomens 2 Ösophagus, Magen und Duodenum. Baltimore: Urban & Schwarzenberg; 1989. p. 17–54.

    Google Scholar 

  7. Orringer MB. Technical aids in performing transhiatal esophagectomy without thoracotomy. Ann Thorac Surg. 1984;38:128–32.

    Article  CAS  PubMed  Google Scholar 

  8. Nakayama K, Yanagisawa F, Nabeya K, Tomita T, Kobayashi S, Makino K. Concentrated preoperative irradiation therapy. Arch Surg. 1963;87:1003–18.

    Article  Google Scholar 

  9. Katsura S. Surgical indication of esophageal cancer, prognosis after surgery, and postoperative complaints and their treatments (in Japanese. Nippon Kyobu Geka Gakkai Zasshi (Jpn J Thorac Cardiovasc Surg). 1957;6:600–5.

    Google Scholar 

  10. Akakura I, Nakamura Y, Kakegawa T, Nakayama R, Watanabe H, Yamashita H. Surgery of carcinoma of the esophagus with preoperative radiation. Chest. 1970;57:47–57.

    Article  CAS  PubMed  Google Scholar 

  11. Seo S. Esophageal surgery (in Japanese). Nippon Geka Gakkai Zasshi (J Jpn Surg Assoc). 1933;33:1461–505.

    Google Scholar 

  12. Osawa T. Esophageal surgery (in Japanese). Nippon Geka Gakkai Zasshi (J Jpn Surg Assoc). 1933;34:1319–590.

    Google Scholar 

  13. Kinoshita I, Ohashi I, Nakagawa K, Kajitani T, Kaneda K, Tsuya A. Lymph node metastasis in esophageal cancer; with special reference to upper mediastinum and measures for its treatment (in Japanese). Nippon Syokaki Geka Gakkai Zasshi (Jpn J Gastroenetrol Surg). 1976;9:424–30.

    Article  Google Scholar 

  14. Sannohe Y, Hiratsuka R, Doki K. Lymph node metastases in cancer of the thoracic esophagus. Am J Surg. 1981;141:216–8.

    Article  CAS  PubMed  Google Scholar 

  15. Kakegawa T, Yamana H, Fujita H. Cervical lymph node dissection during radical esophagectomy (in Japanese). Geka Shinryo (Surg Diagn Treat). 1986;28:523–8.

    Google Scholar 

  16. Isono K, Onoda S, Okuyama K, Tohnosu N. The significance of cervical lymph nodes dissection in radical operation of esophageal cancer (in Japanese). Geka Shinryo (Surg Diagn Treat). 1986;28:529–35.

    Google Scholar 

  17. Muto T, Hasegawa M, Katayanagi N, Sasaki K, Tanaka O. Appraisal of cervical lymph node dissection for thoracic esophageal carcinoma (in Japanese). Geka Shinryo (Surg Diagn Treat). 1986;28:536–40.

    Google Scholar 

  18. Tsurumaru M, Akiyama H, Ono Y, Watanabe G, Udagawa H, Suzuki M. The significance of cervical lymph nodes dissection in radical operation of esophageal cancer (in Japanese). Geka Shinryo (Surg Diagn Treat). 1986;28:555–60.

    Google Scholar 

  19. Japanese Society for Esophageal Diseases. Esophageal cancer—descriptive rules in clinic and pathology (in Japanese). 1st edn. In: Sato H, editor. Tokyo: Japanese Society for Esophageal Diseases; 1969.

  20. International Union Against Cancer. TNM classification of malignant tumours. 1st edn. In: Committee on TNM Classification, editor. Geneva: International Union Against Cancer; 1968.

  21. International Union Against Cancer. TNM classification of malignant tumours. 7th edn. In: Sobin LH, Gospodarowicz MK, Wittekind Ch, editors. New York: Wiley-Blackwell; 2009.

  22. Japanese Research Society for Gastric Cancer. General rules for the gastric cancer in study and pathology (in Japanese). 4th edn. In: Jinnai D, Kajitani T, Kuru M, Maki T, Murakami T, Muto M, Nakayama K, Sakai T, editors. Tokyo: Kanehara; 1965.

  23. Fujita H. The mode of recurrence of esophageal cancer after surgical treatment—autopsy study. Nippon Geka Gakkai Zasshi (J Jpn Surg Assoc). 1984;85:17–28.

    CAS  Google Scholar 

  24. Mitomi T, Makuuchi H, Machimura T, Sugihara T, Sou Y, Sasaki T. Surgery for cancer of the thoracic esophagus: cervical and upper mediastinal lymphadenectomy through an upper median sternotomy (in Japanese). Shujutsu (Oper). 1989;43:1525–31.

    Google Scholar 

  25. Mori S, Kitamura M, Nishihira T. Resection and reconstruction of the thoracic esophagus with special reference to extended lymphadenectomy for the neck and upper mediastinum and esophageal reconstruction (in Japanese). Shujutsu (Oper). 1990;44:53–60.

    Google Scholar 

  26. Akiyama H. Surgery for cancer of the esophagus. Baltimore: Williams & Wilkins; 1990.

    Google Scholar 

  27. Fujita H, Kawahara H, Hidaka M, Nagano T, Yoshimatsu H. An experimental study on viability of the devascularized trachea. Jpn J Surg. 1988;18:77–83.

    Article  CAS  PubMed  Google Scholar 

  28. Fujita H, Kawahara H, Yamana H, Shirouzu G, Yoshimura Y, Minami T, Negoto Y, Irie H, Shima T, Machi J, Kakegawa T. Mediastinal lymphnode dissection procedure during esophageal cancer operation—carefully considered for preserving respiratory function. Jpn J Surg. 1988;18:31–4.

    Article  CAS  PubMed  Google Scholar 

  29. Fujita H, Sueyoshi S, Fujii T, Toh U, Tanaka T, Mine T, Sasahara H, Matono H, Shirouzu K. Functional three-field dissection for esophageal cancer. In: Pinotti HW, Cecconello I, Felix VN, de Oliveira MA, editors. Recent advances in diseases of the esophagus. Bologna: Monduzzi Editore; 2001. p. 525–31.

    Google Scholar 

  30. Cuschieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb. 1992;37:7–11.

    CAS  PubMed  Google Scholar 

  31. Akaishi T, Kaneda I, Higuchi N, Kuriya Y, Kuramoto J, Toyoda T, Wakabayashi A. Thoracoscopic en bloc total esophagectomy with radical mediastinal lymphadenectomy. J Thorac Cardiovasc Surg. 1996;112:1533–41.

    Article  CAS  PubMed  Google Scholar 

  32. Ohsugi H. Radical operation for cancer in the thoracic esophagus, video-assisted thoracoscopic surgery (VATS). Syujutsu (Oper). 2009;63:713–20.

    Google Scholar 

  33. Bodner J, Wykypiel H, Wetscher G, Schmid T. First experiences with the da Vinci™ operating robot in thoracic surgery. Eur J Cardiothorac Surg. 2004;25:844–51.

    Article  CAS  PubMed  Google Scholar 

  34. Suda K, Ishida Y, Kawamura Y, Inaba K, Kanaya S, Teramukai S, Satoh S, Uyama I. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg. 2012;36:1608–16.

    Article  PubMed  Google Scholar 

  35. Isono K, Sato H, Nakayama K. Results of a nationwide study on the three-field lymph node dissection of esophageal cancer. Oncology. 1991;48:411–20.

    Article  CAS  PubMed  Google Scholar 

  36. Kato H, Watanabe H, Tachimori Y, Iizuka T. Evaluation of neck lymph node dissection for thoracic esophageal carcinoma. Ann Thorac Surg. 1991;51:931–5.

    Article  CAS  PubMed  Google Scholar 

  37. Fujita H, Kakegawa T, Yamana H, Hoelscher AH, Bollschweiler E, Siewert JR. The results of en bloc esophagectomy compared with three-field and two-field dissection. In: Nabeya K, Hanaoka T, Nogami H, editors. Recent advances in diseases of the esophagus. Tokyo: Springer; 1993. p. 703–8.

    Chapter  Google Scholar 

  38. Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg. 1994;220:364–73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Fujita H, Kakegawa T, Yamana H, Shima I, Toh U, Tomita Y, Fujii T, Yamasaki K, Higaki K, Noake T, Ishibashi N, Mizutani K. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer; comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg. 1995;222:654–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Kakegawa T, Fujita H, Yamana H. Esophageal cancer: lymphadenectomy based on the lymph node compartment classification. Dig Surg. 1993;10:148–54.

    Article  Google Scholar 

  41. Fujita H, Kakegawa T, Yamana H, Shima I. Lymph node compartments as guidelines for lymphadenectomy for esophageal carcinoma. Dis Esophagus. 1994;7:169–78.

    Google Scholar 

  42. Japanese Society for Esophageal Diseases. Guide lines for clinical and pathologic studies on carcinoma of the esophagus (in Japanese), 9th English edn. In: Tsurumaru H, Ando N, Fumani Y, Ikeda H, Kato H, Matsubara T, Tachimori Y, Kabuto K, Yoshida M, editors. Tokyo: Kanehara; 2001.

  43. Fujita H. History of the Japanese classification of esophageal cancer. Esophagus. 2011;8:233–45.

    Article  Google Scholar 

  44. Yada I, Wada H, Fujita H. Thoracic and cardiovascular surgery in Japan during 2002, annual report by the Japanese Association for Thoracic Surgery. Jpn J Thorac Cardiovasc Surg. 2004;52:491–508.

    Article  Google Scholar 

  45. National Cancer Center, Japan. Center for cancer control and information service. http://ganjoho.jp/professional/statistics/statistics.html.

  46. Fujita H, Kakegawa T, Yamana H, Shima I, Tanaka H, Ikeda S, Nogami S, Toh Y. Lymph node metastasis and recurrence in patients with a carcinoma of the thoracic esophagus who underwent three-field dissection. World J Surg. 1994;18:266–72.

    Article  CAS  PubMed  Google Scholar 

  47. Amano J, Kuwano H, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2011: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2013;61:578–607.

    Article  PubMed  Google Scholar 

  48. Ando N, Kato H, Igaki H, Shinoda M, Ozawa S, Shimizu H, Nakamura T, Yabusaki H, Aoyama N, Kurita A, Ikeda K, Kanda T, Tsujinaka T, Nakamura K, Fukuda H. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.

    Article  PubMed  Google Scholar 

  49. van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berg Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A, CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.

    Google Scholar 

  50. Hironaka S, Ohtsu A, Boku N, Muto M, Nagashima F, Saito H, Yoshida S, Nishimura M, Haruno M, Ishikura S, Ogino T, Yamamoto S, Ochiai A. Nonrandomized comparison between definitive chemoradiotherapy and radical surgery in patients with T2-3NanyM0 squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys. 2003;57:425–33.

    Article  PubMed  Google Scholar 

  51. Swisher SG, Wynn P, Putnam JB, Mosheim MB, Correa AM, Komaki RR, Ajani JA, Smythe WR, Vaporciyan AA, Roth JA, Walsh GL. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg. 2002;123:175–83.

    Article  PubMed  Google Scholar 

  52. Ariga H, Nemoto K, Miyazaki S, Yoshioka T, Ogawa Y, Sakayauchi T, Jingu K, Miyata G, Onodera K, Ishikawa H, Kamei T, Kato S, Ishioka C, Satomi S, Yamada S. Prospective comparison of surgery alone and chemoradiotherapy with selective surgery in resectable squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys. 2009;75:348–56.

    Article  PubMed  Google Scholar 

  53. Tachimori Y. Salvage surgery after chemoradiotherapy for the esophageal carcinoma (in Japanese). Rinsyo Geka (J Clin Surg). 2005;60:193–9.

    Google Scholar 

  54. Stahl M, Stuschke M, Lehmann N, Meyer HJ, Walz MK, Seeber S, Klump B, Budach W, Teichmann R, Schmitt M, Schmitt G, Franke C, Wilke H. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005;23:2310–7.

    Article  PubMed  Google Scholar 

  55. Bedenne L, Michel P, Bouche O, Milan C, Mariette C, Conroy T, Pezet D, Roullet B, Seitz JF, Herr JP, Paillot B, Arveux P, Bonnetain F, Binquet C. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD9102. J Clin Oncol. 2007;25:1160–8.

    Article  CAS  PubMed  Google Scholar 

  56. Harrison LE. Is esophageal cancer a surgical disease? J Surg Oncol. 2000;75:227–31.

    Article  CAS  PubMed  Google Scholar 

  57. Theories on the natural history of breast cancer. [Cited 11/15/1996]. http://darkwing.uoregon.edu/~jbonine/rad02.html.

  58. Halsted WS. The results of radical operation for the cure of carcinoma of the breast. Ann Surg. 1907;46:1–19.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  59. Fisher B. Laboratory and clinical research in breast cancer—a personal adventure: the David A. Karnofsky Memorial Lecture. Cancer Res. 1980;40:3863–74.

    CAS  PubMed  Google Scholar 

  60. Fisher B. From Halsted to prevention and beyond: advances in the management of breast cancer during the twentieth century. Eur J Cancer. 1999;35:1963–73.

    Article  CAS  PubMed  Google Scholar 

  61. Hellman S. Natural history of small breast cancers. J Clin Oncol. 1994;12:2229–34.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

I remain deeply grateful to my teachers, especially to Teruo Kakegawa, Professor Emeritus of Kurume University. He has taught me and inspired me in the field of esophageal surgery, particularly encouraging me to understand the historical point of view.

Author information

Authors and Affiliations

  1. Department of Surgery, Kurume University School of Medicine, Kurume, Japan

    Hiromasa Fujita

  2. Department of Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan

    Hiromasa Fujita

Authors
  1. Hiromasa Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiromasa Fujita.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fujita, H. The history of lymphadenectomy for esophageal cancer and the future prospects for esophageal cancer surgery. Surg Today 45, 140–149 (2015). https://doi.org/10.1007/s00595-014-0841-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-014-0841-4

Keywords

Search

Navigation