3領域リンパ節郭清施行胸部食道癌例における頸部リンパ節転移の検討

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  • CLINICAL SIGNIFICANCE OF METASTASIS TO CERVICAL NODES IN PATIENTS WITH INTRATHORACIC ESOPHAGEAL CANCER WHO HAD EXTENDED LYMPHADENECTOMY

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Two hundred and twenty-five patients with intrathoracic enophageal cancer received extended lymphadenectomy were subjected to a study of the diagnosis of cervical node involvement and the indication of lymphadenectomy. In this study, lymph nodes No.100, 104 and a part of No.101, 102 which demanded cervical approach for dissection were designated cervical lymph nodes. Metastasis to the cervical nodes was found in 17 (8%) patients and a mean number of metastasized nodes was as many as 11.5. Of these 17 patients, no recurrence-free long-term survivor was noted. In six cases of them, cervical nodes involved were less in the depth of invasion as well as the number, but there were many cases of so-called “lymphatic dissemination”. It was thought that the significance of cervical node dissection might be low especially in Ei cases. Cervical lymph nodes are significantly smaller than those of the chest and abdomen. By ROC analysis, the best diagnostic size of cervical nodes for metastasis was the largest diameter of 5mm or more with sensitivity of 80% and specificity of 68%. In conclusion, the patients with metastasis to the cervical nodes might be in a state of lymphatic dissemination with a poor prognosis. Neoadjuvant multimodality therapy should be consider for the patients with nodes lager than 5mm in diameter detected by ultrasonographic examination of the neck.

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