Feedback

Three-Field Lymph Node Dissection for Cancer of the Esophagus

Nasser K. Altorki, MD, Brendon Stiles, MD
Three-Field Lymph Node Dissection for Cancer of the Esophagus is a topic covered in the Pearson's General Thoracic.

To view the entire topic, please or .

STS Cardiothoracic Surgery E-Book from The Society of Thoracic Surgeons provides expert guidance for Cardiac and Thoracic Surgery. Sections include Pearson’s General Thoracic, Esphageal, Adult Cardiac, and Pediatric and Congenital Cardiac Surgery. Explore these free sample topics:

-- The first section of this topic is shown below --

Key Points

  • Three-field lymph node dissection for squamous cell cancer of the esophagus was pioneered by Japanese surgeons. Such an extended resection clearly shows that 25% to 40% of patients have occult metastases to the recurrent laryngeal and/or deep cervical nodes.
  • Western experience with this technique is limited to just a handful of centers where adenocarcinoma is the predominant cell type. The prevalence of occult nodal metastases to the recurrent laryngeal and/or cervical nodes in esophageal adenocarcinoma is 20% to 30% and can be predicted by tumor location, depth of invasion, and by nodal metastatic burden
  • In experienced hands, three-field lymph node dissection can be performed safely with a hospital mortality of less than 5% and with only slightly increased morbidity compared to two-field dissections.
  • In the absence of adequately powered randomized trials comparing two- and three-field dissection, the existing retrospective data suggest that dissection of the “third field” (the recurrent laryngeal and/or cervical nodes) may improve survival of patients with squamous cell carcinoma. This is supported by comprehensive meta-analyses. In patients with adenocarcinoma, the procedure results in optimal nodal staging information; however, its impact on survival is unclear.

-- To view the remaining sections of this topic, please or --

Key Points

  • Three-field lymph node dissection for squamous cell cancer of the esophagus was pioneered by Japanese surgeons. Such an extended resection clearly shows that 25% to 40% of patients have occult metastases to the recurrent laryngeal and/or deep cervical nodes.
  • Western experience with this technique is limited to just a handful of centers where adenocarcinoma is the predominant cell type. The prevalence of occult nodal metastases to the recurrent laryngeal and/or cervical nodes in esophageal adenocarcinoma is 20% to 30% and can be predicted by tumor location, depth of invasion, and by nodal metastatic burden
  • In experienced hands, three-field lymph node dissection can be performed safely with a hospital mortality of less than 5% and with only slightly increased morbidity compared to two-field dissections.
  • In the absence of adequately powered randomized trials comparing two- and three-field dissection, the existing retrospective data suggest that dissection of the “third field” (the recurrent laryngeal and/or cervical nodes) may improve survival of patients with squamous cell carcinoma. This is supported by comprehensive meta-analyses. In patients with adenocarcinoma, the procedure results in optimal nodal staging information; however, its impact on survival is unclear.

There's more to see -- the rest of this entry is available only to subscribers.

Last updated: April 15, 2020