Localization of initial lymph node metastasis from carcinoma of the thoracic esophagus

BACKGROUND, Most surgeons consider esophageal carcinoma with lymph node inv olvement a systemic disease. However, it is possible that the disease may b e localized in the earlier phases of lymphatic metastasis. The distribution of involved lesions in the initial phase of lymph node metastasis has not been thoroughly investigated yet. METHODS. Among 329 patients that underwent curative (RO International Union Against Cancer [UICC]) esophagectomy with systematic mesoesophageal dissec tion, 51 cases of patients with only 1 involved lymph node (solitary involv ement) were retrospectively investigated and compared with patients with mu ltiple involved lymph nodes. The regional lymph nodes were divided into the thoracocervical junction group (lower deep cervical and recurrent nerve ly mph nodes), perigastric group, and intrathoracic group. RESULTS. Lymph node involvement was limited to a solitary lymph node in 46% of lymph node positive patients with esophageal carcinoma confined to the wall (TI and T2, UICC) and in 17% of lymph node positive patients with canc er that invaded the extramural layer (T3 and T4, UICC). Of patients with so litary involvement, 82% had a positive thoracocervical junction or perigast ric lymph node. The 5-year survival rate in solitary involvement cases was 61%, and 65% when solitary involvement was not intrathoracic. Mast of the 5 -year survivors had involvement of a thoracocervical junction or perigastri c lymph node and had not received systemic chemotherapy. CONCLUSIONS. Solitary involvement was not rare and not directly associated with a disseminated disease. Solitary involvement was commonly located in t he thoracocervical junction or abdomen that are accessible without thoracot omy. Systematic dissection of the regional lymph nodes including thoracocer vical junction and perigastric groups is recommended for resectable esophag eal carcinoma at this time. However, less extensive dissection may be perfo rmed in selected cases if the sentinel lymph node concept proves valid. (C) 2000 American Cancer Society.