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J Thorac Cardiovasc Surg 2003;125:1343-1349
© 2003 The American Association for Thoracic Surgery

General Thoracic Surgery

Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus

From the Department of Surgery II,^a Kochi Medical School, Kochi; Department of Anatomy,^b Sapporo Medical University, Sapporo, and Department of Surgery I,^c Kagoshima University, School of Medicine, Kagoshima, Japan.

This work is partly supported by a Grant-in-Aid for Scientific Research (No. 1267-0024) from the Ministry of Education, Science and Culture of Japan.

Received for publication Feb 11, 2002. Revisions requested April 30, 2002; revisions accepted Aug 18, 2002. Accepted for publication Sept 11, 2002. Address for reprints: Gen Murakami, MD, PhD, Department of Anatomy, Sapporo Medical University School of Medicine, South 1, West 17, Sapporo, 060-8556 Japan (E-mail: chisa{at}sapmed.ac.jp).

Objective: To investigate how large submucosal drainage territory extends in lymphatic drainage vessels of the esophagus with and without nodal delay and which morphologies are shown when passing through the muscularis propria.
Methods: Submucosal territories of the 22 highly selected direct drainage vessels of 17 esophagi were histologically examined using transverse or sagittal serial sections. Afferent vessels from the esophagus to the subcarinal (6 esophagi) and para-esophageal (5 esophagi) nodes were also examined to identify their courses and drainage territories.
Results: We found the direct drainage vessel from the esophagus in 17 of 75 cadavers macroscopically (22.7%). A single submucosal drainage unit gave off 1-3 thick drainage vessels passing through a complete muscle gap of the 2 muscular layers. The unit extended longitudinally for >40 mm but was restricted to the right and/or dorsal quadrants of the esophagus. In contrast, drainage routes with a nodal relay originated from the intermuscular area, except 1 case when the adjacent or concomitant esophageal artery and vein provided the complete muscle gap.
Conclusions: Due to the extended longitudinal but restricted transverse territory of the direct drainage system without a nodal relay and because of the suggested much more frequent occurrence in patients than in cadavers, when superficial carcinoma is found in the dorsal and/or right quadrants of the esophagus, we recommend detailed presurgical investigations of cervical nodes. In contrast, afferents from the esophagus to the first regional node usually seemed to be less responsible for early nodal metastasis than the direct drainage route because of their intermuscular origins.

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