J.Jpn. Surg. Soc.. 83(9): 869-873, 1982

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Report on the annual meeting

PROBLEMS IN SURGICAL TREATMENT FOR CARCINOMA OF THE ESOPHAGUS

Lymph nodes to be dissected for carcinoma of the esophagus were classified into 7 groups, superior, middle, lower mediastinal, superior gastric, celiac, common hepatic and splenic artery groups, and frequency of metastases was analyzed in 205 cases. The rates of positive lymph nodes per number of cases and per number of lymph nodes dissected were 59.0% and 6.4% respectively. From studies on distribution of positive nodes according to the location of tumors, it was concluded that complete node dissection of the entire posterior mediastinum, as well as epigastric region is mandatory regardless of the location of tumor. The proximal half of the lesser curvature of the stomach including nodes along the 1st to 5th branches of the left gastric artery should be removed. Dissection of the superior mediastinum is important. When lymph nodes around the innominate artery are dissected, particular care must be taken not to traumatize the right recurrent laryngeal nerve. The left recurrent laryngeal nerve should be preserved when nodes are dissected along the aortic arch and the left side of the trachea. For cases with widely spreading tumor or multiple lesions, effort should be made to obtain en block specimen. Operative mortality rate was 1.4% five year survival rate with negative nodes, with positive nodes, and overall were 53.8%, 15% and 34.6% respectively.

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