Lymphatic Dissemination and Principles of Lymph Node Dissection

Throughout the last decades the results of surgical treatment on esophageal cancer have improved continuously. Before 1980 Isono [1] reported a 5-year survival rate of 12.4%. In this study he describes the mode of recurrence after esophagectomy: 13.0% of patients had local recurrence, 8.7% had recurrence in the residual esophagus, 43.5% had evidence of lymph node metastasis, 28.3% had recurrence in other organs, and 6.5% had pleural or peritoneal tumor dissemination. The relapse pattern in lymph nodes showed recurrence in cervical nodes in 21.7%, mediastinal nodes in 19.6%, and abdominal nodes in 2.2%. These results suggest that extensive surgery with radical lymph node dissection could bear a chance of cure for these patients.