A Proposed Strategy for Treatment of Superficial Carcinoma in the Thoracic Esophagus Based on an Analysis of Lymph Node Metastasis.

Background and Aims : To determine the optimal treatment of superficial carcinoma of the thoracic esophagus, we retrospectively analyzed the site and prevalence of lymph node metastases in three-field dissection specimens removed during radical esophagectomy.Methods : We reviewed the medical charts and surgical and histopathological reports of 34 patients with superficial carcinoma of the thoracic esophagus, who were treated with esophagectomy and three-field lymph node dissection.Results : Lymph node metastases were found in 14 of 34 patients (41%). None of five cases with tumor invasion of only the pEP or pLPM had lymph node metastases. However, the prevalence of lymph node metastases from tumors that invaded the pMM or pSM was 22% and 60%, respectively. Even when the cancer was located in the lower esophagus, the prevalence of cervical lymph node metastases was 20%. Two of three (67%) patients had cervical lymph node metastases even when there were no metastases in mediastinal nodes (“jumping lymph node metastases”). The 5-year survival rates in patients with and without lymph node metastases were 83% and 100%, respectively.Conclusions : A radical esophagectomy with three-field lymph node dissection should be performed on patients who have superficial carcinoma of the thoracic esophagus that invades the pMM or deeper.