Esophageal Cancer

Abstract

Lymph node metastasis has a great significance in the diagnosis and the treatment of esophageal cancer. Esophageal cancer shows more virulent characteristics comparing to gastric or colorectal cancer, and the lymph node dissection during esophageal cancer surgery has more important meaning than that of other gastrointestinal cancer surgeries. The frequency of lymph node metastasis in esophageal cancer is higher than any other gastrointestinal malignancies, and when the depth of tumor invasion is at the submucosal layer, the frequency of lymph node metastasis reaches up to 50%. The distribution of lymph node metastasis is also curious in esophageal cancer. The most frequent site of the metastasis is “along the recurrent laryngeal nerve,” and the second most frequent site is the upper lesser curvature of the stomach; these two sites are far from the primary cancer. The size of the metastasis in the lymph nodes was small; 63% of the metastasis was less than 5 mm in diameter. The completely correct preoperative diagnosis for lymph node metastasis was achieved in only 62.7% of the cases. We usually perform a three-field lymph node dissection esophagectomy. From survival analysis, a lymph node dissection achieved its significance when the pathological number of lymph node metastasis was less than five. However, when the number of lymph node metastasis exceeded five, the procedure of lymph node metastasis would begin to lose its meaning. Then, we may say that the number of lymph node metastasis is a “predictor” AND a “governor.”