LYMPH-FLOW AND LYMPH-NODE METASTASIS IN ESOPHAGEAL CANCER

This paper delineates which lymph nodes should be dissected due to the high frequency of metastasis associated with different types of prima ry lesions of the thoracic esophagus. In cancer involving the upper th ird of the esophagus (Iu), lymph how was found to be primarily from th e superior mediastinal area to the cervical area; in that involving th e middle third (Im), it was broadly distributed from the superior, mid dle, and inferior mediastinal region to the cervical acid abdominal re gions; and in that involving the lower third (Ei), it tended to extend from the inferior mediastinal region to the abdominal region, with si ngle primary metastatic nodes also being noted in this area. The signi ficance of the ''top'' nodes, namely, the nodes located along the righ t recurrent laryngeal nerve in the upper portion of the thorax, was al so investigated, and it was confirmed that the prognosis for patients with metastases to both the top nodes and other nodes was unfavorable. An immunohistochemical study on mediastinal lymph flow using the anti -Su-Ps antibody demonstrated interactions between top nodes and cervic al and/or thoracic nodes.