Lymph node dissection for esophageal cancer
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CURRENT TOPICS REVIEW ARTICLE
Lymph node dissection for esophageal cancer Yasunori Akutsu • Hisahiro Matsubara
Received: 1 February 2013 / Published online: 26 March 2013 Ó The Japanese Association for Thoracic Surgery 2013
Abstract The prevalence of lymph node (LN) metastasis in esophageal cancer (EC) is widely spread to all three fields, namely, to the neck region, the mediastinal region and the abdominal region. Furthermore, the status of LN metastasis has been recognized as a key factor that influences the outcome after EC surgery. Therefore, the latest version of the UICC/AJCC TNM classification (7th edition) applied the number of metastatic LNs as an N factor. However, the precise clinical diagnosis of metastatic LNs is still difficult. This is mainly because there are many micrometastases in EC. Therefore, the Japanese Classification of Esophageal Cancer (10th edition) has not incorporated the number of LN metastases into the N factor for its staging system and the accurate preoperative diagnosis of LN status is currently one of the most important issues to be resolved for EC. Given the frequency and extent of LN metastasis and its significance for the survival, controlling LN metastasis is a rational therapeutic strategy, and an extended LN dissection, such as three-field lymph node dissection may be logical, although appropriate patient selection is necessary. On the other hand, recent arguments have supported a reduction of unnecessary LN dissection in esophagectomy. To curtail unnecessary LN dissection, one of the current topics is sentinel lymph node-guided surgery and is being investigated as part of the next generation surgeries for EC. In this article, recent literatures were
The review was submitted at the invitation of the editorial committee. Y. Akutsu (&) H. Matsubara Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan e-mail: [email protected]
reviewed and we discuss the current status of lymph node dissection in EC. Keywords Esophageal cancer Lymph node dissection Three-field lymph node dissection Sentinel node
Lymph node metastasis and its spread in esophageal cancer Esophageal cancer (EC) is one of the worst malignant digestive neoplasms, and it also has a poor prognosis. The data from the Comprehensive Registry of Esophageal Cancer in Japan, 2004 [1], indicated that the 5-year survival rate after esophagectomy was 50.2 %. Furthermore, the incidence of EC has been increasing in recent decades. To improve the outcome of EC, multidisciplinary treatment has been developed and the survival rates have been improving, however, they are still far from satisfactory [2, 3]. One reason is the high incident rate of lymph node (LN) metastasis compared to other gastrointestinal cancers. For example, our data showed that even in cases of superficial esophageal squamous cell carcinoma, the rates of LN metastasis and LN recurrence were 9 % in m3, 16 % in sm1, 35 % in sm2, and 62 % in sm3 tumors [4]. The frequency o
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