[Evaluation of the treatment of thoracic esophageal carcinoma by the pattern of recurrence].

Among 599 cases of radical esophagectomy 521 cases were examined for recurrent disease. The most common site of recurrence was in the lymph nodes and the second was in the distant organ. One hundred and forty eight patients underwent esophagectomy and esophago-gastric anastomosis in the thoracic cavity, and 421 underwent esophagectomy through the right chest cavity with anastomosis in the neck. Cancer recurred in the lymph nodes of 81 patients in the former group, and 182 in the latter. One hundred and forty eight patients underwent esophagectomy with limited lymphadenectomy, 95 underwent esophagectomy with peri-cardiac and total mediastinal lymph adenectomy, and 46 underwent esophagectomy with lymph adenectomy throughout the entire mediastinum, peri-cardiac area and bilateral neck. The rate of recurrence was 63.8% in the first group, 37.5% in the second and 21.7% in the third. The decrease of rate was largely accounted for by decreased recurrence in the lymph nodes. Twenty three patients received postoperative irradiation only, and 28 received postoperative chemotherapy alone. Among these, 4 (17.4%) and 3 (10.7%) developed recurrences in lymph nodes respectively. These results indicate that the wide lymphadenectomy and postoperative radiotherapy or chemotherapy may be effective in preventing recurrence of esophageal carcinoma.