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J Thorac Cardiovasc Surg 1998;116:954-959
© 1998 Mosby, Inc.

GENERAL THORACIC SURGERY

SURGERY FOR THORACIC ESOPHAGEAL CARCINOMA WITH CLINICALLY POSITIVE CERVICAL NODES

From the Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.

This study was funded from Foundation for Promotion of Cancer Research and in part by Grants-in-Aid for Cancer Research (Nos. 5S-1 and 5-12) from the Ministry of Health and Welfare, Japan.

Received for publication Sept 5, 1997. Revisions requested Feb 9, 1998.Revisions received Aug 20, 1998. Accepted for publication Aug 28, 1998. Address for reprints: Y. Tachimori, MD, Department of Surgery, National Cancer Center Hospital, 1-1 Tsukiji 5-Chome, Chuo-ku, Tokyo 104, Japan.

Objective: We attempted to determine whether and under what circumstances surgical intervention should be recommended for patients with clinically positive cervical nodes for metastasis from thoracic esophageal carcinoma by pretreatment examination.
Methods: The survival of the patients was compared using factors including anatomic subsites of the tumor, T categories, subdivisions of N categories, and R classification according to the TNM classification.
Results: The 5-year survival of 63 patients who underwent surgery for primary therapy was 26.7%. There was no statistically significant difference between the postoperative survivals when compared according to the location of the tumors. As a matter of course, the patients with later stages of the disease had worse survival. However, by the multivariable analysis, significant difference was recognized between the patients with tumor invading adjacent structures (T4) and those without and between the patients who received curative resection and those who did not. The 5-year survival of 47 patients who underwent surgery without residual tumor was 32.9%.
Conclusion: Even when the patient had clinically positive cervical nodes from thoracic esophageal carcinoma, they had a possibility of long-term survival after curative resection with neck lymph node dissection. An operation is thus indicated for curative intent. Accurate pretreatment evaluation is important when deciding which patients require surgery and how to carry out a curative surgical procedure without residual tumor.

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