EVALUATING THE RATIONAL EXTENT OF DISSECTION IN RADICAL ESOPHAGECTOMYFOR INVASIVE-CARCINOMA OF THE THORACIC ESOPHAGUS

To define the rational extent of dissection in radical esophagectomy f or esophageal cancer, survival was studied according to nodal status i n 154 patients undergoing extended radical esophagectomy, The incidenc e of cervical metastasis in patients,vith upper or middle esophageal t umors did not differ between those with favorable (grade N less than o r equal to 4) or unfavorable (grade N greater than or equal to 5) lymp h node status, at 28.6% vs 20%, respectively, On the other hand, in pa tients,vith lower esophageal tumors, the incidence of cervical metasta sis was significantly lower in those with favorable grade (grade N les s than or equal to 4) node status than in those with unfavorable grade (grade N greater than or equal to 5) node status, at 6.5% vs 46.7%, r espectively, Survival did not differ in patients with upper or middle esophageal tumors according to whether they had regional (n = 42) or d istant (n = 15) lymph node metastases, the 5-year survival rates being 11.6% vs 25%, respectively, However, in patients with lower esophagea l tumors, none of 10 patients with distant node metastases survived fo r more than 4 years, whereas the survival rate was 43.7% at 5 years fo r 36 patients,vith regional node metastases. These results show that c ervical lymphadenectomy should only be performed as part of radical es ophagectomy in those patients with upper or middle esophageal cancer.