AN EVALUATION OF NEURAL INVASION IN ESOPHAGEAL CANCER

It is well known that the operative results for esophageal cancer, esp ecially thoracic esophageal cancer, are not favorable. We analyzed the relationship between neural invasion (NI) and histopathologic factors and recurrence types in 104 patients who underwent resection of esoph ageal cancers with T2 or greater depth of invasion of the esophageal w all. The implications of NI as a prognostic indicator were also examin ed. Of the 104 patients, 48 (46.2%) were NI-positive (NI(+)) and 56 (5 3.8%) were NI-negative (NI(-)). The NI(+) patients had a higher ratio of type 3 cancer. Concerning the histopathologic factors, there was a significant relationship between NI and lymph node metastasis (N) and between PI(TI and lymphatic vessel invasion (ly) (P < 0.05). Examining the types of recurrence, namely hematogenous, lymphogenous, and local /stump, as well as pleural or peritoneal dissemination, a relationship was observed between lymphogenous recurrence and N or ly, and between local/stump recurrence and NI. The prognosis of the NI(+) patients wa s significantly different from that of the NI(-) patients. According t o a multivariate analysis, NI and N were significant prognostic factor s. These findings demonstrate that NI is an important prognostic facto r closely related to local recurrence in patients with esophageal canc er. Thus, when treating advanced esophageal cancer with T2 or greater depth of invasion, NI, and lymph node excision should be considered.