Lymph node dissection for thoracic esophageal carcinoma. Two- and 3-field lymph node dissection.

Patients' records were analyzed to evaluate the effect of lymph node dissection on the survival of patients with thoracic esophageal carcinoma. Patients who underwent incomplete resection of the tumor were excluded from this study. A conventional lower mediastinal and abdominal lymph node dissection (conventional 2-field dissection) had been performed in 410 patients. A complete dissection of the upper mediastinal nodes was performed in addition in 121 patients (extended 2-field dissection). Sixty-four patients underwent a further dissection of the cervical periesophageal lymph nodes through the thoracic cavity (super-extended 2-field dissection). A cervical, mediastinal, and abdominal lymph node dissection was carried out in another 100 patients (3-field dissection). Background factors in the latter three groups were similar. Mean numbers of dissected lymph nodes in extended 2-field, super extended 2-field, and 3-field dissections were 32, 57, and 77, respectively. Operative mortality rates were 11%, 9%, and 3%, respectively. The five-year survival rates for patients who underwent extended 2-field or 3-field dissection were 43% and 61%; the difference was statistically significant (P = 0.000113). The four-year survival rate for super-extended 2-field dissection was 53%. Among those patients who underwent 3-field dissection, 58 (58%) had histologically positive lymph nodes. Their five-year survival rate was 47%. The patients' survival has been improved by increasing the field of lymph node dissection without deterioration of operative mortality.