Indications for abdominal para-aortic lymph node dissection in patients with esophageal squamous cell carcinoma.
BACKGROUND
Abdominal para-aortic lymph node (APAL) dissection of esophageal cancer is not widely accepted. The aim of this article is to propose the indications for APAL dissection in esophageal cancer patients from the viewpoint of micrometastases.


METHODS
To evaluate the value of APAL dissection in patients with esophageal cancer, the status of APAL metastases and recurrence in 230 patients with esophageal squamous cell carcinoma (1989 to 1998) was examined retrospectively. On the basis of our findings, 16 patients received a prophylactic APAL dissection from January 1999 to March 2001. Micrometastases in the dissected lymph nodes were examined using cytokeratin staining and reverse transcription-polymerase chain reaction of squamous cell carcinoma antigen messenger RNA.


RESULTS
Among the 230 patients who had esophageal squamous cell carcinoma, 21 had APAL metastases (including micrometastases) or APAL recurrence. Among the 21 patients with APAL metastases and recurrence, 20 (95.2%) had metastases (including micrometastases) in perigastric lymph nodes (paracardial and lesser curvature nodes). Among 51 patients with lower thoracic esophageal carcinoma, 13 (25.5%) had APAL metastases or recurrence. On the basis of these results, prophylactic APAL dissection was performed in patients with lower thoracic esophageal cancer who were suspected of perigastric lymph node metastases during operations. APAL metastases (including micrometastases) were detected in 6 (38%) of these patients, and 2 patients with APAL micrometastases survived without recurrence. However, 7 patients had hematogenic recurrence after the operation.


CONCLUSIONS
Our results suggested that the indications for APAL dissection were limited. Patients with lower thoracic esophageal cancer who are suspected to have perigastric lymph node metastasis and APAL micrometastases may be considered for APAL dissection.
Department of Surgery and Surgical Basic Science, Graduate School of Medicine, Kyoto University, Kawaracho Shogoin Sakyo-ku, Japan.
Yutaka
Y
Shimada
Masayuki
M
Imamura
Fumiaki
F
Sato
Masato
M
Maeda
Jun-Ichi
J
Kaganoi
Yosuke
Y
Hashimoto
Takatsugu
T
Kan
Shiro
S
Nagatani
Zhigang
Z
Li
D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000032:analysis; D001012:Aorta, Abdominal; D002294:Carcinoma, Squamous Cell / Q000737:chemistry / Q000556:secondary / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012333:RNA, Messenger / Q000032:analysis; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D015843:Serpins
D000951:Antigens, Neoplasm; D012333:RNA, Messenger; D015843:Serpins; C051072:squamous cell carcinoma-related antigen; D007633:Keratins