Lymph Node Metastasis in Squamous Cell Carcinoma of the Intrathoracic Esophagus

Background. In esophageal carcinoma lymph node metastasis is one of the most important factors of prognosis. This prospective study evaluated the incidence and extent of lymph node metastasis, and assessed the relationship between the depth of tumor invasion and lymph node metastasis in esophageal carcinoma. Methods. Between 1985 and 1996, tissue samples from 112 patients undergoing radical esophagectomy and gastric substitution for squamous cell carcinoma of the intrathoracic esophagus were collected. Patients with distant organ metastasis were excluded. All specimens were evaluated and sent for histopathologic examination. Results. In 108 men and four women with a mean age of 63.1 years, the average number of dissected lymph nodes in one surgical procedure, was 30 per person. The most commonly involved nodes were the periesophageal (42.9%) and the perigastric (42.9%) nodes, followed by the recurrent laryngeal nerve (23.8%) and thoracic paratracheal (22.2%) nodes. For tumors in the upper third of the esophagus, the most frequently involved nodal groups were the periesophageal (28.6%) and the paratracheal (28.6%) nodes, followed by the recurrent laryngeal nerve (21.4%) the deep cervical (21.4%), and the perigastric (21.4%) nodes. For tumors in the middle third of the esophagus, the periesophageal nodes (27.3%) were most commonly involved, followed by the perigastric (18.2%) and the subcarina (10.6%) nodes. For tumors in the lower third of the esophagus, the perigastric lymph nodes (37.5%) were the most common nodal metastatic site, followed by the celiac (18.8%) and the recurrent laryngeal nerve (18.2%) nodes. Depth of tumor invasion was also found to correlate significantly with lymph node metastasis (p = 0.0015). Conclusions. Wide lymph node metastasis between the neck and the upper abdomen occurs frequently in squamous cell carcinoma of the esophagus. For potentially curable esophageal carcinomas, en-bloc esophagectomy with complete locoregional lymph node dissection may provide favorable local control of the lesion and more accurate tumor staging.