Significance of lymph node dissection of the superior mediastinal region in esophageal cancer patients.

The effect of the superior mediastinal lymph node dissection was compared retrospectively with that of standard dissection in 108 esophageal cancer patients. Five-year survival rates were 46.3% in patients who underwent standard surgery (group A) and 39.3% in patients who underwent superior mediastinal lymph node dissection (group B). The survival curves were basically the same. Nineteen out of 42 (45.2%) tumors in group A and 24 out of 66 (36.4%) tumors in group B recurred. The distribution of the first sites of recurrence did not differ significantly between groups. However, 14 tumors (67%) in group A recurred in the lymph nodes, but only seven tumors recurred (28%) in the lymph nodes in group B. Eleven tumors (52%) in group A recurred to superior mediastinal nodes, but only one tumor (4%) recurred to a superior mediastinal node in group B. Fourteen of the group B patients showed metastasis to superior mediastinal lymph nodes and none of these patients survived for more than 5 years. Eleven of these 14 patients showed metastasis to only one or two nodes. Based on our data and other reported findings, we conclude that extended lymphadenectomy of the superior mediastinal region alone does not contribute to improved survival of esophageal cancer patients, but it does contribute to the prevention of lymph node recurrence in this region.