LYMPH-NODE METASTASIS AND THE RECURRENCE OF ESOPHAGEAL-CARCINOMA WITHEMPHASIS ON LYMPHADENECTOMY IN THE NECK AND SUPERIOR MEDIASTINUM

A series of 335 patients with squamous cell carcinoma of the thoracic esophagus undergoing resection and reconstruction via a right thoracot omy and laparotomy with cervical anastomosis between 1973 and 1990, we re reviewed. Prior to 1982, the removal of lymph nodes was limited to the nodes in the mediastinum below the tracheal bifurcation and upper abdomen (142 patients). Nodal metastases were found in 89 of these pat ients at operation. The upper abdominal nodes were the most frequent s ites of metastasis (47.2%). None of the 38 patients with positive node s sampled from the neck and superior mediastinum survived for more tha n 45 months. In the 50 patients with recurrences, 30 were in the neck and/or superior mediastinum. During or after 1983, the superior medias tinal nodes, particularly the bilateral recurrent nerve nodal chains, were routinely removed (193 patients). Nodal metastasis was proven in 131 of the 193 patients, in whom 87 (45.1%) had metastasis in the neck and superior mediastinum. Eleven of these 87 patients survived for 45 months or more. In the 61 patients with recurrences, 20 were in the n eck and/or superior mediastinum. These data suggest that recurrent ner ve nodal chains should be removed to improve survival in patients with esophageal carcinoma.