Clinical significance analysis of lymph node metastasis on the middle and lower segment of 186 cases of II and III stage of esophageal squamous cell carcinoma patients

Abstract

Objective To investigate lymph node metastasis on the middle and lower segment of Ⅱ and Ⅲ stage of esophageal squamous cell carcinomas, understand the factors influencing the lymph node metastasis, and provide the basis for the key areas of lymph node cleaning. Methods A retrospective study was made on the specimens of 186 patients who were middle and lower segment of Ⅱ and Ⅲ stage of esophageal squamous cell carcinomas, who had underwent radical operation through left thoracic, thoraco abdominal two field lymph node cleaning. All the cases were patients from April 2010 to December 2013 at the Inner Mongolia Medical University Clinical Medical College of Chifeng. Results A percentage (67.9%) of patients (126/186) was found with lymph node metastasis. A total of 4259 lymph node was dissected, with an averaged cleaning of (22.9±8.1) lymph nodes for each case. A total of 622 lymph nodes (14.6%=622/4 259) existed metastasis. The rate of mediastinum metastasis for middle and lower segment of esophageal cancer was 56.1% and 16.5%, respectively. The rate of metastasis to the lower mediastinal lymph nodes was 34.6% and 54.4%, respectively. The rate of metastasis to the celiac lymph nodes was 23.4% and 46.8%, respectively. A significant difference was found in the metastasis locations of middle and lower segment of esophageal carcinomas (P 0.05). Conclusions The lower segment of Ⅱ, Ⅲ stage esophageal squamous cell carcinoma with lymph node metastasis occurs in the lower mediastinal and abdominal lymph nodes. The middle segment Ⅱ, Ⅲ stage esophageal squamous cell carcinoma with lymph node metastasis occurs in the thoracic and abdominal lymph nodes with Jump transfer characteristics. The lymph node cleaning of the middle segment includes the left artery near the stomach, paraesophageal, and carina lymph node. The lymph node cleaning of the lower segment includes paraesophageal, cardia, and gastric lymph nodes. The metastasis rate of vascular tumor thrombus is related to the depth of tumor invasion and differentiation degree. Key words: Esophageal neoplasms/pathology; Neoplasms, squamous cell/pathology; Lymphatic metastasis; Retrospective studies