CERVICAL, MEDIASTINAL, AND ABDOMINAL LYMPH-NODE DISSECTION (3-FIELD DISSECTION) FOR SUPERFICIAL CARCINOMA OF THE THORACIC ESOPHAGUS

Background. The recent increase in the number of esophageal carcinomas detected at an early stage has prompted debate about the most suitabl e treatment for them. Methods. Forty-three patients with superficial e sophageal carcinoma (SEC) underwent esophagectomy with cervical, media stinal, and abdominal lymph node dissection (three-field dissection). On the basis of the pathologic data and results of surgery, the adequa cy of treatment was discussed. Results. Three patients with pTis tumor had no positive lymph nodes. Twenty patients (46.5%) had positive nod es in the resected specimen. Nineteen lesions (57.6% of submucosal can cers) with lymph node metastasis had invasion to the submucosa. Five p atients with submucosal cancer (15.2% of submucosal cancers) had posit ive nodes in the neck. The lymph nodes along the right recurrent nerve and the right paracardiac nodes were the most frequent site of metast asis (16.3%), whereas the right paratracheal, infracarinal, infra-aort ic arch, common hepatic, and celiac nodes had no metastasis. The opera tive mortality rate was 2.3%. Recurrent disease occurred in three pati ents with submucosal cancer. The 5-year survival rate after surgery wa s 73.2% for all 43 patients and 68.6% for patients with positive nodes . Conclusions. Esophagectomy with three-field lymph node dissection is recommended for patients with lesions diagnosed as submucosal cancer. Endoscopic mucosectomy is applicable as a first-choice treatment for patients with esophageal carcinoma at Tis.