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J Thorac Cardiovasc Surg 1998;115:1225
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Is cervical involvement a sign of incurable disease in cancer of the thoracic esophagus?

Nasser K. Altorki, MD, David B. Skinner, MD

Reply to the Editor:

We thank Professor Matsubara for his kind comments regarding our article and respectfully acknowledge his numerous contributions to the field. He quite correctly points out that the number of patients in our series was small; however, in our updated experience of nearly 50 patients the data still hold. Approximately 40% of patients with tumors in the middle third of the thoracic esophagus (mostly squamous cancers) have metastasis to the cervicothoracic regions, specifically the recurrent nerve nodes, and approximately 25% to 30% of patients with tumors in the lower third of the esophagus (mostly adenocarcinomas) have metastases to that region. We agree with Professor Matsubara that comparisons between lung and esophageal cancers are probably not warranted because these anatomic neighbors have patently different pathways of lymphatic drainage.

We also find that metastasis to the azygos nodes and the nodes in front of the trachea are an uncommon occurrence in esophageal cancer. Finally, we believe that although randomized trials have become the gold standard for reaching definitive conclusions regarding therapeutic interventions, they are by no means the only way of assessing the efficacy of an intervention. Data that are prospectively acquired and carefully documented and controlled form the basis of time-honored observational studies that have advanced the cause of medicine over the years. It would seem unlikely in our opinion that a randomized trial comparing three-field dissection (or a radical two-field dissection) to lesser resections would result in any meaningful results, primarily because of the understaging of the disease that is an inherent defect in all limited resections.

Department of Cardiothoracic SurgeryNew York Hospital–Cornell Medical Center525 East 68th St., Room F-2212, New York, NY 1002112/8/89144





This Article
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David B. Skinner
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