Three-field lymph node dissection for squamous cell and XXXX .

@entity1 @entity1544 @entity418 @entity3 @entity204 @entity420 @entity7145
OBJECTIVE: To determine the prevalence of occult cervical nodal metastases in @entity1 with @entity1544 and @entity7145 , and to determine the impact of esophagectomy with three-field lymph node dissection on survival and recurrence rates. SUMMARY BACKGROUND DATA: Although esophagectomy with three-field lymph node dissection is commonly practiced in Japan, its role in the surgical management of @entity418 in the United States, especially in @entity1 with @entity420 , is essentially unknown. METHODS: This is a prospective observational study of esophagectomy with three-field lymphadenectomy. Eighty @entity1 underwent resection between August 1994 and April 2001. Clinicopathological information and follow-up data were collected on all @entity1 until @entity204 or June 2001. RESULTS: Hospital mortality and morbidity rates were 5% and 46%, respectively. @entity3 to the recurrent laryngeal and/or deep cervical nodes occurred in 36% of @entity1 irrespective of cell type ( @entity420 37%, squamous 34%) or location within the esophagus (lower third 32%, middle third 60%). Overall 5-year and disease-free survival rates were 51% and 46%, respectively. Sixty-nine percent presented with nodal metastases. The 5-year survival rate for node-negative @entity1 was 88%; that for those with nodal metastases was 33%. The 5-year survival rate in @entity1 with positive cervical nodes was 25% (squamous 40%, @entity420 15%). CONCLUSIONS: Esophagectomy with three-field lymph node dissection can be performed with a low mortality and reasonable morbidity. Unsuspected metastases to the recurrent laryngeal and/or cervical nodes are present in 36% of @entity1 regardless of cell type or location within the esophagus. Thirty percent of @entity1 were upstaged, mainly from stage III to stage IV. An overall 5-year survival rate of 51% suggests a true survival benefit beyond that achieved solely on the basis of stage migration.
