Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic oesophagus

Background: Lymph node metastasis is commonly found in carcinoma of the tho racic oesophagus, even when the tumour invades only the submucosa. Although lymph node status greatly influences the outcome, the pattern of early lym phatic spread has not been investigated, and the role of lymph node dissect ion is still a matter of controversy. Methods: A series of 110 patients with superficial carcinoma who underwent systematic extended lymph node dissection was investigated retrospectively. Results: Lymph node involvement was found in 0 per cent (none of nine), 23 per cent (five of 22) and 49 per cent (38 of 78) of tumours that invaded th e lamina propria, muscularis mucosa and submucosa respectively. Anatomicall y distant lymph nodes (recurrent nerve nodes and perigastric nodes) were in volved more frequently than other intrathoracic nodes adjacent to the main tumour. Only three patients had involvement limited to the intrathoracic gr oup, and in carcinoma that invaded only the muscularis mucosae, all metasta tic nodes were located at the thoracocervical junction or in the abdomen. T he 5-year survival rate was 89 per cent in the node-negative group and 54 p er cent in the node-positive group (P < 0.0003). Conclusion: The recurrent nerve nodes and perigastric nodes are the princip al proximal regional lymph nodes involved in superficial carcinoma of the t horacic oesophagus. Systematic lymph node dissection, which included these nodes, yielded an acceptable and favourable outcome in patients with node-p ositive superficial carcinoma.