OUTCOMES OF EXTENDED RADICAL ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER

Background: Great controversy exists concerning the adequate extent of esophagectomy for cure in patients with esophageal cancer. Extended r adical esophagectomy combined with three-field lymphadenectomy has bee n performed to improve the cure rates for patients with the disease in Japan. The purposes of this study were to assess the mortality and mo rbidity rates after extended radical esophagectomy and to determine th e oncologic indications for this procedure. Study Design: We reviewed 190 patients who underwent extended radical esophagectomy for invasive esophageal cancer. The procedures were performed prospectively betwee n 1982 and 1996. Results: The 30-day mortality, in-hospital mortality, and morbidity rates were 1.6%, 4.7%, and 58.4%, respectively. The mos t common postoperative complication was vocal-cord paralysis (45.3%), followed by major pulmonary complications (21.6%). The overall surviva l rate for the 190 patients was 41.5% at 5 years, with a median follow up period of 61 months. Some subgroups of patients had an extremely po or prognosis despite extended radical esophagectomy. Survival was less than or equal to 5 years in all patients with five or more positive n odes; all patients with simultaneous metastases to the cervical, media stinal, and abdominal lymph nodes; and all patients with cervical meta stases from a lower esophageal tumor. Conclusions: Extended radical es ophagectomy is potentially associated with high morbidity rates althou gh the mortality rates are acceptable, suggesting the necessity of car eful patient selection. This procedure is indicated oncologically only for patients with four or fewer metastatic nodes or with metastases c onfined to one or two of the three anatomic compartments (neck, medias tinum, and abdomen) from upper or midesophageal tumors. (C) 1998 by th e American College of Surgeons.