Prognostic evaluation of patients with clinical T1 and T2 squamous cell carcinomas of the thoracic esophagus after 3-field lymph node dissection

Abstract

Background. Clinicopathologic characteristics and outcomes with clinical T1 and T2 squamous cell carcinomas requiring surgical resection have not been well investigated. The purpose of this study was to evaluate results for patients undergoing 3-field lymph node dissection and to elucidate predictors of survival. Methods. From January 1988 to January 1998, 336 patients with carcinomas of the thoracic esophagus underwent transthoracic esophagectomy with 3-field lymph node dissection. Of these, 325 (97%) patients had squamous cell carcinomas. A total of 139 (41%) with clinical T1 and T2 tumors were retrospectively analyzed based on the prospectively established database. Results. Among the 139 patients with clinical T1 and T2 squamous cell carcinomas, 90 (65%) had T1 and 49 (35%) had T2 tumors. The operative morbidity, and 30-day and in hospital mortality rates were 70%, 0%, and 2%, respectively. Macroscopic and microscopic complete resection of the primary tumor and removal of metastatic nodes were accomplished in 90% of the cases. The overall 1-, 3-, and 5-year survival rates were 88%, 72%, and 61%. Significant prognostic factors, determined by multivariate analysis, were number of lymph node metastases, pathologic T status, and completeness of resection. Number of lymph node metastases most strongly affected survival. Eighty-six percent of patients with 5 or more metastatic nodes occurred recurrence of disease. Conclusion. Esophagectomy with 3-field lymph node dissection accomplishes a high feasibility of complete resection of primary tumor and removal of metastatic nodes in patients with clinical T1 and T2 squamous cell carcinomas. Five or more metastatic nodes can be considered as an indicator of systemic disease with a high likelihood of distant organ metastasis. This variable must be taken into consideration for deciding clinical disease stage and treatment strategy. (Surgery 2003;133:368-74.)