title: Radical lymph node dissection for cancer of the thoracic esophagus.
abstract: OBJECTIVE
  The authors documented the localization and frequency of lymphatic spread in squamous cell carcinoma of the thoracic esophagus and evaluated the influence of radical systematic lymph node dissection on patient survival.
  
  
  BACKGROUND
  From accumulated surgical experience, it was suggested that some of the patients with lymph nodal involvement from cancer could be cured by its clearance. However, it is only recently that cancer of the esophagus has been evaluated in terms of analyzing lymphatic spread and results of lymphadenectomy.
  
  
  METHODS
  Among 1298 patients admitted to the Toranomon Hospital between 1973 and 1993, 913 (70.3%) had resections, including curative and palliative procedures. For this study, 717 patients with TNM RO (resection with no residual tumor at operation in TNM classification) were analyzed. Survival was compared between groups of patients with less extensive thoracoabdominal (two-field) dissections and extensive collothoracoabdominal (three-field) dissections.
  
  
  RESULTS
  Comparative study revealed that 5-year survival rate for TNM RO patients after free-field dissection (55.0%) was significantly better (log rank test, p = 0.0013) than the rate after two-field dissection (38.3%). The results were particularly significant in subgroups with stage III and IV (because of nodal factor). Overall 5-year survival rate after all resections was 42.4%.
  
  
  CONCLUSIONS
  The role of radical lymph node dissection in cancer of the thoracic esophagus evaluated. Long-term survival was compared between two groups with two- and three-field dissection. It was concluded that survival rate was significantly better in patients with extensive three-field dissection.
authors.affiliation: Department of Surgery, Toranomon Hospital, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Akiyama
authors.forename: M
authors.initials: M
authors.lastname: Tsurumaru
authors.forename: H
authors.initials: H
authors.lastname: Udagawa
authors.forename: Y
authors.initials: Y
authors.lastname: Kajiyama
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D015996:Survival Rate; D013909:Thorax