Prognosis in esophageal carcinoma with cervical lymph node metastases.

BACKGROUND: The purpose of this study was to assess cervical lymph node (C-LN) metastases and to examine whether the site of the C-LN metastasis impacts on survival of the patient with thoracic esophageal cancer.

METHODS: Transthoracic esophagectomy and three-field dissection (mediastinal, abdominal, and C-LN) followed by esophageal reconstruction were performed on 68 patients with squamous cell carcinoma of the thoracic esophagus who were seen at our institution from 1983 to 1990.

RESULTS: C-LN metastasis was seen in 20 (29.4%) patients, and the survival curve of the 20 patients with positive C-LN metastasis was not significantly different from that of the 48 patients without positive C-LN metastasis. The survival curve of patients (n = 7) with positive node limited to recurrent laryngeal nerve chain node (RLN group) was significantly better than that of patients (n = 13) with positive internal jugular nodes including supraclavicular nodes (IJN group) (p = 0.010; generalized Wilcoxon). This was because there were more patients in the IJN group (84.6%) than in the RLN group (28.6%) (p = 0.022) who had five or more positive nodes in the three fields.

CONCLUSIONS: The results suggest that RLN should not be defined as M1 but as N1 in thoracic esophageal cancer.