title: Esophagectomy with extended lymphadenectomy for submucosal esophageal cancer: long-term outcomes and prognostic factors.
abstract: BACKGROUND
  There are controversies regarding the extent of lymphadenectomy necessary during the course of esophagectomy for submucosal esophageal cancer. The purpose of this study was to examine the long-term outcomes after esophagectomy with extended lymphadenectomy in patients with submucosal esophageal cancer and to investigate the prognostic factors in these patients.
  
  
  METHODS
  A prospectively maintained database identified 105 previously untreated patients with submucosal esophageal cancer who underwent transthoracic esophagectomy with three-field or two-field lymphadenectomy. Median follow-up was 101 months.
  
  
  RESULTS
  All patients received R0 resection. Ninety-eight patients had squamous cell carcinoma, and seven had adenocarcinoma. Lymph node metastasis was present in 38 patients (36.2%), of whom 9 patients (23.7%) had positive cervical nodes. Thirty-five patients (33.3%) had other primary malignancies. The overall 5- and 10-year survival rates were 74.4 and 57.4%, respectively. The cause of death was recurrent disease in 16 patients, other malignancy in 12, and noncancer-related disease in 18. Univariate analyses demonstrated that other primary malignancy (P = 0.0041), poor differentiation (P = 0.0203), and angiolymphatic invasion (P = 0.0347) significantly affected overall survival. There was no difference in survival between patients with lymph node metastasis and those without (P = 0.9809). Multivariate analysis found other primary malignancy to be the only independent prognostic factor (hazards ratio, 2.295; 95% confidence interval, 1.201-4.386; P = 0.0119).
  
  
  CONCLUSIONS
  Esophagectomy with extended lymphadenectomy for submucosal esophageal cancer results in 57.4% survival at 10 years. Other primary malignancy is the only independent predictor affecting long-term survival. Patients should be examined rigorously for other primary malignancy as well as recurrent disease during long-term follow-up.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan. totanaka@med.kurume-u.ac.jp
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Satoru
authors.initials: S
authors.lastname: Matono
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagano
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shirouzu
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Fujita
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yamana
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate