Total esophagectomy versus proximal esophagectomy for esophageal cancer atthe cervicothoracic junction

To investigate the adequate extent of esophagectomy and lymphadenectomy for an esophageal cancer localized at the cervicothoracic junction, the mortal ity and morbidity rates, survival rates, and patterns of recurrence were re trospectively analyzed in two groups-14 patients who underwent total esopha gectomy with or without laryngectomy and 15 patients who underwent proximal esophagectomy with or without laryngectomy-at Kurume University Hospital f rom 1981 to 1996. Proximal esophagectomy with or without laryngectomy resul ted in a lower hospital mortality rate and better overall survival for pati ents who underwent curative esophagectomy compared with total esophagectomy with or without laryngectomy. Multivariate analysis indicated that the ext ent of esophagectomy (total esophagectomy versus proximal esophagectomy) wa s not a prognostic factor. The incidence of recurrence was not different be tween the two groups. Lymph node metastasis or recurrence from such esophag eal cancers was localized to the neck and upper mediastinum. For an esophag eal cancer localized at the cervicothoracic junction, therefore, proximal e sophagectomy with or without laryngectomy and with cervical and upper media stinal lymphadenectomy could be better indicated for preselected patients.