title: Efficacy of lymph node dissection by node zones according to tumor location for esophageal squamous cell carcinoma.
abstract: BACKGROUND
  The extent of node dissection in esophageal cancer surgery is usually estimated by the number of resected nodes, irrespective of the area of dissection. The efficacy of lymph node dissection by area was evaluated according to the location of the primary tumor.
  
  
  METHODS
  The study group comprised the 3827 patients who underwent R0 esophagectomy with three-field lymph node dissection for squamous cell carcinoma, registered in a nationwide registry in Japan. The areas of lymph node were classified into zones according to AJCC Staging Manual. The Efficacy Index (EI) calculating the frequency and patient survival of metastases to each zone was investigated according to tumor location.
  
  
  RESULTS
  The EI was high in supraclavicular and upper mediastinal zones in patients with upper esophageal tumors, highest in upper mediastinal zone followed by supraclavicular and perigastric zones in patients with middle esophageal tumors, and highest in perigastric zone followed by upper and lower mediastinal zones in patients with lower esophageal tumors. In patients with middle and lower esophageal cT1 tumors, the EIs of upper mediastinal and perigastric zones were higher than middle and lower mediastinal zones.
  
  
  CONCLUSIONS
  The EIs of each zone were differed by tumor location. The extent of lymph node dissection should be estimated by the dissected zones and modified by the tumor location. Supraclavicular dissection is indispensable for patients with upper esophageal tumors, and recommended for patients with middle esophageal tumors. Upper mediastinal dissection is recommended for all patients with thoracic esophageal squamous cell carcinoma, irrespective of the location.
authors.affiliation: Division of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tachimori
authors.affiliation: Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Soji
authors.initials: S
authors.lastname: Ozawa
authors.affiliation: Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hodaka
authors.initials: H
authors.lastname: Numasaki
authors.affiliation: Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shinoda
authors.affiliation: Department of Gastroenterological Surgery, Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Toh
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
authors.forename: Harushi
authors.initials: H
authors.lastname: Udagawa
authors.affiliation: Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.affiliation: Department of Gastroenterology, Saku General Hospital, Nagano, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Oyama
authors.affiliation: Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Uno
keywords: Esophageal cancer; Lymphadenectomy; Metastasis; Squamous cell carcinoma; Survival