Abstract
Early, distant and/or skip metastasis of squamous-cell thoracic esophageal cancer frequently occurs in the right recurrent nerve node (recR). However, the specific lymphatic route without a nodal relay, such as the submucosal ascending route, was not known for the recR afferent. Using 20 donated cadavers, macroscopic, and histological observations were performed on the recR and its surrounding lymphatics, especially afferent routes from the esophagus to the recR. Most afferent vessels of the recR originated from the right paratracheal node. However, the recR often (12/20) received a major submucosal lymphatic drainage route ascending along the thoracic esophagus. The submucosal vessel came out of the esophagus and ran in a longitudinal connective tissue mass along the right tracheo-esophageal groove. A direct drainage route was often (13/20) seen from the recR to the venous system. Moreover, because of the specific histology, collaterals seemed to be present around the recR. In the regional nodes of the intrathoracic esophagus, the recR histology was characterized by the high proportion of lymphocyte accumulating areas or the cortex. From the midthoracic level, metastatic cancer cells seemed to reach the recR via esophageal submucosal vessels in the early stage. Large lymphocyte accumulating areas of the recR suggested higher filtration capacity than other distal nodes. However, the collateral of the recR and its direct drainage to the venous system suggested that the recR involvement often corresponds to a systemic disease.
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, Ono Y, Udagawa H, Kajiyama Y (1992) Background of lymph node dissection for squamous cell carcinoma of the esophagus. In: Sato T, Iizuka T (eds) Color atlas of surgical anatomy for esophageal cancer. Springer, Tokyo, pp 9–24, 26
Altorki N, Skinner D (2001) Should en bloc esophagectomy be the standard of care for esophageal carcinoma?. Ann Surg 234:581–587
Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M (2000) Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg 232:225–232
Igaki H, Kato H, Tachimori Y, Nakanishi Y (2000) Cerviscal lymph node metastasis in patients with submucosal carcinoma of the thoracic esophagus. J Surg Oncol 45:37–41
Igaki H, Kato H, Tachimori Y, Daiko H, Fukaya M, Yajima S, Nakanishi Y (2001) Clinicopathologic characteristics and survival of the patients with clinical stage I squamous cell carcinomas of the thoracic esophagus treated with three-field lymph node dissection. Eur J Cardiothoracic Surg 20:1089–1094
Kato H, Tachimori Y, Watanabe H, Iizuka T, Terui S, Itabashi M, Hirota T (1991) Lymph node metastasis in thoracic esophageal carcinoma. J Surg Oncol 48:106–111
Kinoshita I, Ohashi I, Nakagawa K, Kajitani T, Kaneda K, Tsuya A (1976) Lymph node metastasis in esophageal cancers with special reference to the upper mediastinum and measures for its treatment (in Japanese with English abstract). Jpn J Gastroenterol Surg 9:424–430
Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N, Watanabe M, Ohgami M, Otani Y, Ozawa S, Hasegawa H, Furukawa T, Kumai K, Ikeda T, Nakahara T, Kubo A, Kitajima M (2000) The role of the sentinel lymph node in gastrointestinal cancer. Surg Clin North Am 80:1799–1809
Kuge K, Murakami G, Mizobuchi S, Hata Y, Aikou T, Sasaguri S (2003) Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus. J Thorac Cardiovasc Surg 125:1343–1349
Matsubara T, Ueba M, Abe T, Akimori T, Kokudo N, Takahashi T (1999) Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic esophagus. Br J Surg 86:669–673
Matsubara T, Ueda M, Kaisaki S, Kuroda J, Uchida C, Kokudo N, Takahashi T, Nakajima T, Yanagisawa A (2000) Localization of initial lymph node metastasis from carcinoma of the thoracic esophagus. Cancer 89:1869–1873
Mizutani M, Nawata S, Hirai I, Murakami G, Kimura W (2005) Anatomy and histology of Virchow’s node. Anat Sci Int 80:193–198
Murakami G, Sato T, Tkiguchi T (1990) Topographical anatomy of the bronchomediastinal lymph vessels: their relationships and the formation of the collecting trunks. Arch Histol Cytol 53(Suppl):219–235
Murakami G, Taniguchi I (2004) Histological heterogeniety and intranodal shunt flow in lymph nodes from elderly subjects: a cadaveric study. Ann Surg Oncol 11:279S–284S
Murakami G, Abe M, Abe T (2002) Last-intercalated node and direct lymphatic drainage into the thoracic duct from the thoracoabdominal viscera: a review. Jpn J Thorac Cardiovasc Surg 50:93–103
Negus D, Edwards JM, Kinmonth JB (1970) Filling of cervical and mediastinal nodes from the thoracic duct and the physiology of Virchow’s node—studies by lymphography. Br J Surg 57:267–271
Qubain SW, Natsugoe M, Matsumoto M, Nakashima S, Baba M, Takao S, Aikou T (2001) Micrometastasis in the cervical lymph nodes in esophageal squamous cell carcinoma. Dis Esophagus 14:143–148
Rice TW, Zuccaro Jr G, Adelstein DJ, Rybicki LA, Blackstone EH, Goldblum JR (1998) Esophageal carcinoma: depth of tumor invasion is predictive of regional lymph node status. Ann Thorac Surg 65:787–792
Rice TW (1999) Superficial oesophageal carcinoma: is there a need for three-field lymphadenectomy?. Lancet 354:792–794
Sato A, Taniguchi I, Fujiwara D, Ichikawa H, Suzuki M, Nawata S, Murakami G (2003) Gaps and fragmentation of the superficial cortex in the abdominal and pelvic lymph nodes of elderly Japanese. Anat Sci Int 78:211–222
Tabira Y, Kitamura N, Yoshioka M, Tanaka M, Nakano K, Toyota N, Mori T (1999) Significance of three-field lymphadenectomy for carcinoma of the thoracic esophagus based on depth of tumor infiltration, lymph nodal involvement and survival rate. J Cardiovasc Surg 40:737–740
Tabira Y, Yasunaga M, Tanaka M, Nakano K, Sakaguchi T, Nagamoto N, Ogi S, Kitamura N (2000) Recurrent nerve nodal involvement is associated with cervical nodal metastasis in thoracic esophageal carcinoma. J Am Coll Surg 191:232–237
Takemura M, Osugi H, Takada N, Kinoshita H, Higashino M (2003) Prognostic factors in patients with squamous oesophageal cancer associated with solitary lymph node metastasis after oesophagectomy and extended lymphadenectomy. Oncol Rep 10:75–80
Taniguchi I, Murakami G, Sato A, Fujiwara D, Ichikawa H, Yajima T, Kohama G (2003) Lymph node hyalinization in elderly Japanese. Histol Histopathol 18:1169–1180
Vickery CW, Hollowood AD, Barham CP, Hardwick RH, Alderson D (2000) Investigating the proximal limit of lymphadenectomy in patients with adenocarcinoma of the oesophagus in the mid-thoracic region. Br J Surg 87:362–373
Yoshioka S, Fujiwara Y, Sugita Y, Okada Y, Yano M, Tamura S, Tsuda T, Takiguchi S, Shiozaki H, Monden M (2002) Real-time rapid reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: clinical application for cervical lymph node dissection in esophageal cancers. Surgery 132:34–40
Acknowledgements
We are grateful to Mrs. Masako Kuronuma in Yamagata University for her active work for preparation if histological sections. We also thank Dr. Daisuke Suzuki and Dr. Yusuke Kinugasa in Sapporo Medical University for their assistances for preparation of figures.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mizutani, M., Murakami, G., Nawata, Si. et al. Anatomy of right recurrent nerve node: why does early metastasis of esophageal cancer occur in it?. Surg Radiol Anat 28, 333–338 (2006). https://doi.org/10.1007/s00276-006-0115-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-006-0115-y