Is upper mediastinal lymphadenectomy necessary in squamous carcinoma of the lower thoracic oesophagus?

Aim: We examined the indication of upper mediastinal lymphadenectomy for a squamous cell carcinoma of the lower thoracic oesophagus. Methods: 49 patients underwent a curative oesophagectomy with upper mediast inal lymphadenectomy for a squamous cell carcinoma of the lower thoracic oe sophagus. Node status and clinicopathological characteristics of these pati ents were reviewed retrospectively. Results: 16 (94.1%) of 17 patients with superficial tumours had no positive node in the upper mediastinum. Nine (29.0%) of 31 patients with transmural tumours had positive nodes in the upper mediastinum (P = 0.04). Ten (20.4% ) of 49 patients had many positive nodes in the upper mediastinum. Of these 10 patients, 6 patients had 5 or more positive nodes in all. The 5-year su rvival rate for patients with 5 or more positive nodes was 7.7%, which was significantly poorer than patients with 4 or fewer positive nodes. Conclusions: Upper mediastinal lymphadenectomy is unnecessary in most of th e superficial squamous carcinomas of the lower thoracic oesophagus.