SURGERY OF SQUAMOUS-CELL CARCINOMA OF THE ESOPHAGUS

Identification of prognostic factors which may influence survival in p atients with squamous cell carcinoma of the esophagus is critical for the selection of those patients who benefit from a surgical resection and the choice of the radicality of the procedure. We evaluated the tu mor characteristics which independently influenced survival in 249 con secutive patients with squamous cell carcinoma of the esophagus who ha d undergone en bloc resection and 2-field lymphadenectomy. Multivariat e analysis in the entire patient population identified (1) the pT cate gory, (2) the pN category, (3) more than 7 positive mediastinal lymph nodes, and (4) the presence of residual tumor after resection, i.e. a R1 or R2 resection, as the only independent factors influencing surviv al time. In a second multivariate analysis of 94 patients who survived the procedure for at least 30 days, who had a R0 resection, and who d id not have preoperative neoadjuvant therapy, only the pN-category, th e presence of more than 7 positive mediastinal lymph nodes, and the ra tio between positive and removed mediastinal lymph nodes independently influenced survival. These data suggest that only a R0 resection, i.e . complete macroscopic and microscopic tumor removal, can increase sur vival in patients with squamous cell carcinoma of the esophagus. In pa tients with a limited number of positive mediastinal lymph nodes the p rognosis may be improved by a 2-field lymphadenectomy, if the number o f removed mediastinal lymph nodes exceeds the number of positive nodes by a factor of at least 5.