Lymph node dissection in surgical treatment of esophageal neoplasms

Background. Until now therapy of carcinoma of the esophagus has presented a n aura of pessimism, resulting in an attitude among physicians that cure wa s impossible. Presently the overall 5-year survival is between 38.3 % and 5 5% thanks to new radical surgical techniques. The aim of this work is to ev aluate lymph node dissection in treatment of esophageal carcinoma by analyz ing morbidity, mortality, survival and quality of life. Methods. From 1975 to 1995, 170 patients with carcinoma of the esophagus an d cardia underwent operation, of whom 165 underwent 2-field lymphadenectomy and four 3-field lymphadenectomy; one patient was submitted to selftranspl anting jejunal loop to neck. One hundred and twenty-two patients had "stand ard" resection and 47 "en bloc" resection. Results. Lymph node involvement is often found in patients with superficial carcinoma and it greatly influences outcome after esophagectomy. In 2-fiel d lymphadenectomy morbidity and mortality are more frequent in "en bloc' re sections; global 3-year survival was better in patients with early lesions. Three-field lymphadenectomy was performed in only few cases, not sufficien t to express a definitive opinion. Conclusions. On the basis of our experience, we conclude that the better su rvival is particularly dependent on early diagnosis, histological type of n eoplasia and following surgical treatment, especially on the type of resect ion with 2 or 3-field lymphadenectomy.