A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus.
BACKGROUND
Recurrence of thoracic esophageal carcinoma in the cervical and superior mediastinal lymph nodes occurs frequently and contributes to a poor prognosis. Extensive lymphadenectomy has been advocated. Findings in support of this to date, however, have been based on a comparison with historical controls. We herein report a prospective randomized trial of extended and conventional lymphadenectomy.


METHODS
Cases of thoracic esophageal carcinoma meeting criteria predictive of complete resection were randomized into conventional and extended cervical and superior mediastinal lymphadenectomy groups.


RESULTS
In the extended and conventional lymphadenectomy groups, respectively, mean operative time was 487 +/- 47 and 396 +/- 43 minutes, blood loss was 850 +/- 429 and 576 +/- 261 mL, node count was 82 +/- 22 and 43 +/- 15, hospital deaths occurred in 3% and 7%, 2-year survival was 83.3% and 64.8%, 5-year survival was 66.2% and 48.0%, and recurrence rate was 19.9% and 24.1%.


CONCLUSIONS
Extended lymphadenectomy may prevent recurrence and prolong survival after resection of thoracic esophageal carcinoma.
Nishihira
T
T
Second Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.
Hirayama
K
K
Mori
S
S
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008482:Mediastinum; D008875:Middle Aged; D009333:Neck; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D013909:Thorax; D013997:Time Factors