Value of the two field lymphadenectomy in the treatment of esophageal cancer

Surgical procedures including the extent of systematic lymphadenectomy are still under discussion in the treatment of esophageal cancer. In the own patients' population 92 subtotal en bloc-esophagectomies with a standard two field lymphadenectomy were performed. A total of 1483 lymph nodes were resected in the thoracic and abdominal compartments with an incidence of 16,1% being metastatic. Stage pN1 disease occurred in 57,6% of the patients. The median number of lymph nodes resected in each specimen was 16, independent of tumor stage, -site or R-classification. The number of infiltrated nodes increased with tumor stages. R-classification, tumor stage and number of involved lymph nodes could be analyzed as prognostic factors. After RO-resection a median survival rate of 25,4 months could be achieved, following pNO-stage that of 27,4 months. In case of two metastatic lymph nodes the prognosis decreased significantly to 14,4 months (p<0,01). Therefore, two field lymphadenectomy may show a therapeutic benefit only in a subgroup of patients with a limited number of lymph nodes infiltrated.