APPLICATION OF LOCOREGIONAL CHEMOTHERAPY USING LYMPH-DIRECTED SUBSTANCES IN A CANINE TRANSHIATAL ESOPHAGECTOMY MODEL

We investigated whether lymph-directed substances injected into the me diastinal connective tissue of dogs reached the regional lymph nodes o f the esophagus. In 46 dogs, 1.5 mt of cuttlefish particles or activat ed carbon particles containing 15 mg of bleomycin (CH-BLM) was injecte d at two sites: into the connective tissue between the trachea and the aorta via mediastinoscopy in 23 dogs (16 with cuttlefish particles an d 7 with CH-BLM: mediastinal group), and into the crura of the diaphra gm by means of laparotomy in 23 dogs (16 with cuttlefish particles and 7 with CH-BLM: crural group). Cuttlefish particles, distinguished by decolorization with melanin bleaching, showed selective affinity for l ymphatics. When cuttlefish particles were injected into mediastinal co nnective tissue, the rate of staining (# of black-stain positive nodes /# of examined nodes) was higher in the crural group than in the media stinal group. In the crural group, bleomycin activity in lymph nodes w as higher in the regions from the neck to the abdominal para-aortic re gion than at the injection site, excluding the peri-gastric region. If the topography of lymphatics and lymph flow kinetics in man are simil ar to that of the dog, then the crura of the diaphragm appears to be a potentially effective site for applying loco-regional chemotherapy fo r carcinoma of the esophagus in patients undergoing transhiatal esopha gectomy.