Between 1980 and 1997, 1194 patients with a malignant tumor of the lower esophagus have been observed and treated in our Institution. There were 555 patients (46.5 %) presenting with squamous-cell carcinoma, 101 (8.5 %), with Barrett's adenocarcinoma and 538 (45 %) with cardia adenocarcinoma. Most patient underwent a transthoracic esophagectomy with esophagogastroplasty; transhiatal approach was mainly reserved to high-risk patients. Over the past two years sixty-three patients (42 with adenocarcinoma and 21 with squamous cell carcinoma) underwent enlarged mediastinal lymphadenectomy. Three patients (4.7 %) died post-operatively: one sepsis, in pulmonary embolism and one myocardial infarction. Four patients (6.3 %) developed pulmonary complications; no patient had recuriential palsy. Pathologic exam revealed 1342 nodes (807 thoracic and 827 abdominal). Twenty patients (31.7 %) had mediastinal nodal metastases, of which 8 in the upper mediastinum. Median follow-up was 19 months (2-36 months). Seven of the sixteen patients with recurrent disease (12 sistemic, 3 mediastinal and 1 anastomotic) died. The number of metastatic nodes increased with serial section and even more with immunohistochemical staining technique (from 11.7 % to 13 % to 15.5 %, respectively). Two patients were up-staged from M0 to M1 because of peripancreatic nodal micrometastases. We conclude that enlarged mediastinal lymphadenectomy allowed to detect upper mediastinal lymph node metastases in 12.8 % of patients without increasing post-operative complication rate. A longer follow-up is required to evaluate the impact on long term survival.
|Translated title of the contribution||Contribution of wide node dissection in cancers of the lower esophagus and cardia|
|Number of pages||5|
|Journal||Journal de Chirurgie|
|Publication status||Published - Nov 1997|
ASJC Scopus subject areas