A new N category for cancer of the cervical esophagus based on lymph node compartments

Background. There remains controversy over what constitutes the optimal rational extent of lymphadenectomy, in other words, the concept of rational lymphadenectomy, for cancer of the cervical esophagus. The purpose of this study was to propose the concept of a rational N category for cancer of the cervical esophagus that indicates more clearly which cluster(s) of lymph nodes should be resected during resection of a cancer of the cervical esophagus. Methods. This study reviews the actual incidence of metastasis in the resected lymph nodes in a consecutive series of 36 patients with a cancer of the cervical esophagus who underwent curative resection. The regional lymph nodes were subsequently classified into three compartments based on the metastatic rates and prognosis after lymphadenectomy. Results. In cases of cancer in the cervical esophagus with invasion into the pharynx (CePh), high rates of positive metastasis were found in the cervical paraesophageal (101) and in the deep cervical nodes (102), and resection of those nodes showed improved prognosis. In cases of cancer in the cervical esophagus without invasion into the pharynx (Ce/CeUt), high rates of positive metastasis were found in the cervical paraesophageal (101) and in the recurrent nerve nodes (106rec), and resection of those nodes showed improved prognosis. In both cases, however, resection of the mediastinal nodes except for the recurrent nerve nodes (106rec) showed no improvement in prognosis. Only in cases where the cancer involves the pharynx did resection of the peripharyngeal nodes (103) show improved prognosis. Conclusions. The Compartment-I (N1) nodes for cancer of the cervical esophagus with invasion into the pharynx (CePh) were concluded to be the cervical paraesophageal (101) and the deep cervical nodes (102); the Compartment-II (N2) nodes to be the peripharyngeal (103), the supraclavicular (104), and the recurrent nerve nodes (106rec); and the Compartment-III (N3) nodes to be the superficial cervical (100) and the upper thoracic paraesophageal nodes (105). The Compartment-I (N1) nodes for cancer of the cervical esophagus without invasion into the pharynx (Ce/CeUt) were concluded to be the cervical paraesophageal (101) and the recurrent nerve nodes (106rec); the Compartment-II (N2) nodes to be the deep cervical (102) and the supraclavicular nodes (104); and the Compartment-III (N3) nodes were concluded to be the superficial cervical (100) and the upper thoracic paraesophageal nodes (105). © 2008 Japan Esophageal Soceity and Springer.