Recurrent nerve nodal involvement is associated with cervical nodal metastasis in thoracic esophageal carcinoma

Background: Because three-field dissection for esophageal carcinoma is one of the most invasive operations, this procedure should be selected only whe n strictly indicated; but there are no useful criteria for it. The goal of this study was to identify the useful clinicopathologic factors for indicat ing three-field dissection. Study Design: In this study, we reviewed the survival of patients after thr ee-field dissection and identified factors associated with metastases in ce rvical nodes (CN), especially internal jugular nodes and supraclavicular no des. Eighty-six patients who underwent curative esophagectomy with three-fi eld dissection for squamous cell carcinoma of the thoracic esophagus were e nrolled in this study. Survival rates were compared with respect to the pre sence of nodal metastasis. The relationship between recurrent nerve nodal ( RNN) involvement and CN metastasis (bilateral internal jugular nodes, supra clavicular nodes, or both) was examined. Clinicopathologic factors possibly influencing CN metastasis were studied by multivariate logistic regression analysis. Results: The overall 5-year survival rate was 45.1%. The 5-year survival ra te for patients without metastatic nodes was 67.5%, for patients with one t o four metastatic nodes it was 53.1%, and for patients with five or more it was 9.1%. The prognosis of those with five or more metastatic nodes was si gnificantly poorer than those of the other two groups. In the positive-node group, the 5-year survival rate for patients with RNN metastasis was 21.7% , and for patients with negative RNN it was 47.0% (p = 0.2). In the positiv e-node group, the 5-year survival rate for patients with positive CN was 13 .7% and for patients with negative CN it was 45.8% (p = 0.01). Fifty-six (8 8.9%) of 63 patients without RNN metastasis had no CN metastasis in contras t to 13 of 23 patients (56.5%) with RNN metastasis who had no CN metastasis (p = 0.001). The positive predictive value, negative predictive value, sen sitivity, and specificity were 43.5%, 88.8%, 58.8%, and 81.2%, respectively . The number of metastatic nodes (5 or more versus 0-4) (odds ratio: 2.9, 9 5% Confidence Interval (CI)= 1.6-5.5, p = 0.0008) and RNN involvement (odds ratio: 4.5, 95% CI = 1.3-15.9, p = 0.02) were the significant factors asso ciated with CN metastasis in the multivariate analysis. Conclusions: RNN involvement is associated with CN metastasis as is the num ber of metastatic nodes and may be an indicator for the selection of three- field dissection in thoracic esophageal carcinoma. (J Am Coil Surg 2000;191 :232-237. (C) 2000 by the American College of Surgeons).