Surgical treatment of esophageal cancer: Tokyo experience of the three-field technique

Esophageal cancer can metastasize to the lymph nodes at a very early stage of the disease, and spread occurs both upwards and downwards. We have devel oped the 'three-field lymphadenectomy' (3-FD) technique, in which more than 100 lymph nodes are completely dissected from the lower neck. mediastinum, and upper abdomen. More than 700 patients have undergone 3-FD since 1984. Three-field lymphadenectomy is associated with considerable morbidity, alth ough efforts have been made to reduce this by preserving tracheobronchial c irculation and innervation. The mortality associated with 3-FD is acceptabl e (5-year survival rate of 53.8% for patients treated with curative surgery ). We believe that 3-FD is a suitable standard operation for the treatment of thoracic esophageal cancer. Further trials are now under way with the ai m of improving the results of the technique and also extending the applicat ions of limited surgery and non-surgical therapy.