Cervical, mediastinal, and abdominal lymph node dissection (three–field dissection) for superficial carcinoma of the thoracic esophagus

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Abstract
Background. The recent increase in the number of esophageal carcinomas detected at an early stage has prompted debate about the most suitable treatment for them. Methods. Forty‐three patients with superficial esophageal carcinoma (SEC) underwent esophagectomy with cervical, mediastinal, and abdominal lymph node dissection (three‐field dissection). On the basis of the pathologic data and results of surgery, the adequacy of treatment was discussed. Results. Three patients with pTis tumor had no positive lymph nodes. Twenty patients (46.5%) had positive nodes in the resected specimen. Nineteen lesions (57.6% of submucosal cancers) with lymph node metastasis had invasion to the submucosa. Five patients with submucosal cancer (15.2% of submucosal cancers) had positive nodes in the neck. The lymph nodes along the right recurrent nerve and the right paracardiac nodes were the most frequent site of metastasis (16.3%), whereas the right paratracheal, infracarinal, infra‐aortic arch, common hepatic, and celiac nodes had no metastasis. The operative mortality rate was 2.3%. Recurrent disease occurred in three patients with submucosal cancer. The 5‐year survival rate after surgery was 73.2% for all 43 patients and 68.6% for patients with positive nodes. Conclusions. Esophagectomy with three‐field lymph node dissection is recommended for patients with lesions diagnosed as submucosal cancer. Endoscopic mucosectomy is applicable as a first‐choice treatment for patients with esophageal carcinoma at Tis.