Abstract
Background
Three-field lymph node dissection for thoracic esophageal cancer is associated with high morbidity and reduced quality of life after surgery. Consequently, minimized lymphadenectomy would be desirable, if appropriate. In the present study, we retrospectively analyzed the status of involved nodes and the direction of metastatic lymphatic flow from tumors into involved nodes to determine whether submucosal squamous cell esophageal cancers are potential candidates for minimized lymphadenectomy.
Methods
We enrolled 199 patients who received esophagectomy with extensive lymph node dissection between 1989 and 2005 and retrospectively analyzed their prognoses, distribution of solitary metastatic lymph nodes, and the direction of metastatic lymphatic flow from the tumor, taking into consideration tumor location and depth.
Results
Of these patients with submucosal cancers, 83% had 1 or 2 involved nodes, and their esophageal cancer-specific 5-year survival rate was 66%. Solitary lymph node metastasis did not occur in neck lymph nodes in lower thoracic submucosal esophageal cancers, and the direction of metastatic lymphatic flow from the tumor was almost always in one direction. By contrast, T2–4 cancers with 2–4 involved nodes had bidirectional metastatic lymphatic flow from the tumor.
Conclusions
There was a difference in the status of lymph node metastasis and the direction of metastatic lymphatic flow from tumors into involved nodes between submucosal and T2–4 thoracic squamous cell esophageal cancers. This analysis may be useful for developing an approach to minimized lymphadenectomy for thoracic esophageal cancers.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Akiyama H, Tsurumaru M, Udagawa H et al (1994) Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 220:364–372
Igaki H, Tachimori Y, Kato H (2004) Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg 239:483–490
Fujita H, Kakegawa T, Yamana H et al (1995) Mortality and morbidity rates, postoperative course, quality of life and prognosis after radical lymphadenectomy for esophageal cancer. Ann Surg 222:654–662
Murakami G, Abe M, Abe T (2002) Last-intercalated node and direct lymphatic drainage into the thoracic duct from the thoracoabdominal viscera. Jpn J Thorac Cardiovasc Surg 50:93–103
Motoyama S, Kitamura M, Saito R et al (2006) Outcome and treatment strategy for mid- and lower thoracic esophageal cancer recurring locally in the lymph nodes of the neck. World J Surg 30:191–198
Japan Society for Esophageal Diseases (2004) Guidelines for clinical and pathologic studies on carcinoma of the esophagus, ninth edition: preface, general principles, part I. Esophagus 1:61–88
Motoyama S, Ishiyama K, Maruyama K et al (2007) Preoperative mapping of lymphatic drainage from the tumor using ferumoxide-enhanced magnetic resonance imaging in clinical submucosal thoracic squamous cell esophageal cancer. Surgery 141:736–747
Imano H, Motoyama S, Saito R et al (2004) Superior mediastinal and neck lymphatic mapping in mid- and lower-thoracic esophageal cancer as defined by ferumoxides-enhanced magnetic resonance imaging. Jpn J Thorac Cardiovasc Surg 52:445–450
Hironaka S, Ohtsu A, Boku N et al (2003) Nonrandomized comparison between definitive chemoradiotherapy and radical surgery in patients with T(2–3)N(any) M(0) squamous cell carcinoma f the esophagus. Int J Radiat Oncol Biol Phys 57:425–433
Law S, Kwong DL, Kok KF et al (2003) Improvement in treatment results and long-term survival of patients with esophageal cancer. impact of chemoradiation and change in treatment strategy. Ann Surg 238:339–347
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Motoyama, S., Maruyama, K., Sato, Y. et al. Status of Involved Lymph Nodes and Direction of Metastatic Lymphatic Flow Between Submucosal and T2-4 Thoracic Squamous Cell Esophageal Cancers. World J Surg 33, 512–517 (2009). https://doi.org/10.1007/s00268-008-9781-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-008-9781-8