The application of three-field lymph node dissection in esophageal cancer surgery

Abstract

Esophageal cancer is a common malignancy worldwide. Although multidisciplinary treatment has improved the prognosis of esophageal cancer, its fatality rate remains high. Since lymph node metastases can primarily occur from the cervical to the abdominal field, a strategy for extended lymph node (LN) dissection has been established. The three-field LN dissection (3FLD) during a transthoracic esophagectomy which is defined as a procedure for cervico-thoraco-abdominal LN dissection, was established in the 1 980 s’ in Japan, and is currently widely accepted throughout the world. To date, various comparative trials between 3FLD and two-field LN dissections (2FLD) have been reported and showed that a transthoracic esophagectomy with 3FLD is superior to 2FLD for prognosis. However, in 3FLD, postoperative complications, such as recurrent laryngeal nerve palsy and postoperative gastrointestinal dysfunction can be induced. Recently, the efficacy of intense perioperative treatment for esophageal cancer has been reported, and the significance of minimally invasive surgical procedures is being verified. The ideal combination of perioperative treatment and feasible surgery must be established to improve the oncological outcome of esophageal cancer patients further. Key words: Esophageal cancer; Lymph node metastases; Three-field lymph node dissection