Prognostic evaluation for squamous cell carcinomas of the lower thoracic esophagus treated with three-field lymph node dissection

Objective: The efficacy of esophagectomy with three-field lymph node dissection in surgical treatment for patients with squamous cell carcinomas of the lower thoracic esophagus remains controversial. This report documents the outcomes of this surgical procedure for a large series. Methods: From February 1986 to November 1998, 437 patients with squamous cell carcinomas of the thoracic esophagus underwent transthoracic esophagectomy with three-field lymph node dissection. One hundred and sixteen of these had cancer of the lower thoracic esophagus, To avoid the influence of adjuvant therapy on survival, 20 who also received radiation and/or chemotherapy were excluded, leaving 96 patients who were retrospectively analyzed. Results: The operative morbidity, and 30-day and in-hospital mortality rates were 62, 0, and 3%, respectively. The overall 1-, 3-, and 5-year survival rates were 89, 65, and 59%, with a median survival of 76 months. In those with lymph node metastases (66% of cases), the values were 87, 56, and 48%, as compared with 94, 84, and 79%, respectively (P = 0.005) for patients without lymph node metastasis. Factors significantly influencing the overall survival rates were patient age (greater than or equal to 65 vs. < 65), clinical N status (cN1 vs. cN0), clinical M status (cM1 1 vs. cM0), longitudinal turner length of resected specimen (<greater than or equal to>5 vs. < 5 cm), pathologic T status (pT3 vs, pT1, 2), pathologic N status (pN1 vs. pN0), lymphatic invasion (positive vs. negative), vascular invasion (positive vs. negative) and intramural metastasis (present vs, absent). independent prognostic factors for survival determined by multivariate analysis were pathologic T status (P = 0.02), pathologic N status (P = 0.03), and presence of intramural metastasis (P = 0.03). Additional pathologic M1 status, cervical or celiac lymph node metastasis, was without significant influence. Conclusions: Patients with pathologic T3 tumors with both pathologic N I status and the presence of intramural metastasis in the lower thoracic esophagus had a poor prognosis. Cervical or celiac lymph node metastasis in patients with carcinomas of the lower thoracic esophagus should he distinguished from pathologic M1 status in the UICC-TNM staging system. (C) 2001 Elsevier Science B.V. All rights reserved.