title: Extensive lymphadenectomy for thoracic esophageal carcinoma: a two-stage operation for high-risk patients.
abstract: Extensive lymphadenectomy (ELA) for esophageal carcinoma has always been limited to low-risk patients; however, we have developed a two-stage operation which extends the indications for ELA to include certain high-risk patients. Of 70 patients who underwent transthoracic subtotal esophagectomy for thoracic esophageal carcinoma between 1986 and 1991, 48 qualified for ELA which was performed on 45, including 27 low-risk patients (group A) whom underwent the traditional one-stage operation, while 18 high-risk patients underwent the two-stage operation (group B). The number of hospital deaths and postoperative complications was similar between the two groups. The median survival was 26 months in group B and 17 months in group A. The 40-day delay in resection of the neck and abdominal nodes in the two-stage operation did not significantly affect lymph node metastases, postoperative recurrence, or long-term survival. Thus, the two-stage operation is an oncologically meaningful approach to the treatment of high-risk patients who present with thoracic esophageal carcinoma.
authors.affiliation: First Department of Surgery, Oita Medical University, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Saito
authors.forename: K
authors.initials: K
authors.lastname: Shimoda
authors.forename: Y
authors.initials: Y
authors.lastname: Shigemitsu
authors.forename: T
authors.initials: T
authors.lastname: Kinoshita
authors.forename: M
authors.initials: M
authors.lastname: Miyahara
authors.forename: M
authors.initials: M
authors.lastname: Kobayashi
mesh_terms: D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012306:Risk; D015996:Survival Rate