Extensive lymph node clearance for cancer of the esophagus or cardia: merits and limits in reference to 5-year absolute survival.

Background/aims: The present study evaluates both merits and limits of extensive lymph node clearance in the mediastinum and upper abdomen on patients operated on more than 5 years ago.

Materials And Methods: One hundred forty-four esophageal cancer patients underwent subtotal (n = 97) or distal (n = 47) esophageal resection more than 5 years ago. Twenty-six patients operated on in a curative attempt were given radiotherapy (n = 14) or radiochemotherapy (n = 12).

Results: Esophagectomy with extensive lymph node clearance was feasible in 102 of the 144 patients (70.8%). In-hospital mortality was 1.4%. Thirty-six patients lived more than 5 years, ie. 25% of all the esophagectomized patients and 35.3% (36/102) of those who were operated on in a curative attempt. Five-year absolute survival was 38.4% after combined therapy v.s. 34.2% after surgery alone (p > 0.05). In the latter instance, it was 57.1% for those patients with normal lymph nodes v.s. 14.6% for those with metastatic lymph nodes, and it was 64% for those with non-transmural tumors v.s. 19.6% for those with transmural tumors. One half of those patients who were not given adjuvant therapy following esophagectomy with extensive lymph node clearance died of neoplastic spread, namely distant metastases (27.6%), cervical spread (3.9%), and local recurrence (10.5%).

Conclusions: Esophagectomy with extensive lymph node clearance is not feasible in 30% of the patients in whom it is attempted, and it does not prevent further neoplastic spread in one half of those in whom it is feasible. It is capable of curing 15 to 20% of those patients with locally advanced neoplasms and shelters 90% of the patients from local recurrence.