Total esophagectomy versus proximal esophagectomy for esophageal cancer at the cervicothoracic junction

Pattern of Lymphatic Spread of Esophageal Cancer at the Cervicothoracic Junction Based on the Tumor Location : Surgical Treatment of Esophageal Squamous Cell Carcinoma of the Cervicothoracic Junction

BACKGROUND

There is no consensus about the extent of lymphadenectomy for patients with esophageal squamous cell carcinoma at the cervicothoracic junction (CT-ESCC). The purpose of this study was to examine the pattern of lymph node spread in patients with CT-ESCC and the extent of lymphadenectomy that is necessary.

METHODS

We included 64 consecutive patients with CT-ESCC who underwent surgery. All patients were divided into two groups based on the location of the epicenter or anal edge of the primary tumor. Using the height of the epicenter, 27 and 37 patients were classified as having cervical-centered and thoracic-centered tumors, respectively; while, using the height of the anal edge, 38 and 26 patients had tumors that were cervical-localized and thoracic-invading, respectively.

RESULTS

In the patients with cervical-centered tumors, the incidences of metastasis and/or recurrences in the cervical paraesophageal, supraclavicular, and upper mediastinal nodes were 21.4-28.5 %. No patient had metastasis or recurrence in the middle and lower mediastinal and perigastric nodes. In patients with thoracic-centered tumors, the lymph node metastasis and/or recurrence spread to the cervical paraesophageal (41.7 %), supraclavicular (25 %), and upper mediastinal (55.6 %) nodes, as well as the middle (22.2 %) and lower mediastinal (8.3 %) and perigastric (19.4 %) nodes. There was no difference in the distribution and incidence of lymphatic spread between patients with the cervical-localized and thoracic-invading classifications.

CONCLUSIONS

Our results indicate a cervical and upper mediastinal lymphadenectomy is better indicated for patients with cervical-centered CT-ESCC, whereas patients with thoracic-centered CT-ESCC should be treated with a three-field lymphadenectomy.

Surgical management of carcinoma of the cervical esophagus

OBJECTIVES

The aim of the present study was to clarify the clinicopathological characteristics, reconstruction methods after resection, and prognosis of cervical esophageal squamous cell carcinoma.

METHODS

Seventy-four with squamous cell carcinomas of the cervical esophagus not previously treated who underwent cervical esophagectomy or total esophagectomy with or without laryngectomy were retrospectively analyzed.

RESULTS

The operative morbidity and in-hospital mortality rates were 34% (25 patients) and 4% (3 patients), respectively. Alimentary continuity was achieved with free jejunal transfer (50 patients), gastric pull-up (19 patients), and other procedures (5 patients). The frequencies of postoperative complications and death did not differ between free jejunal transfer and gastric pull-up. The overall 3- and 5-year survival rates were 42% and 33%, respectively. The significant clinicopathological factors affecting survival were patient gender, high T factor, lymph node involvement, palpable cervical lymph nodes, vocal cord paralysis, lymphatic invasion, and extracapsular invasion. The pattern of first failure was most often locoregional (82%, 36 patients).

CONCLUSION

The choice of free jejunal transfer or gastric pull-up for reconstruction after surgical resection of cervical esophageal carcinoma depends on the degree of tumor extension. Adverse factors affecting survival should be considered when candidates for the surgery are selected.

[Cervical and upper-third thoracic oesophageal carcinoma: a single pathological entity?]

AIM OF THE STUDY

Cervical and upper-third thoracic oesophageal carcinomas are considered as a single pathological entity. The aim of this study was to compare postoperative and oncological results after surgical resection in these two locations.

MATERIAL AND METHODS

Postoperative and oncological results were compared retrospectively in 155 patients who underwent surgery for carcinoma of the cervical (C group, n = 21) or upper-third thoracic (TS group, n = 134) oesophagus.

RESULTS

The two groups were comparable regarding the pre-, peroperative and histological data. Postoperative mortality and morbidity rates in the C and TS groups were 4.8% and 10.4% (P= 0.413) and 57.1 and 50.7% (P= 0.585), respectively. R0 resection and recurrence rates were 61.9% and 73.1% (P= 0.289) and 50.0% and 51.1% (P= 0.941), respectively. Five-year survival rates were 0% and 35% in the overall population (P= 0.098) and 0 and 49% in the R0 population (P= 0.047), respectively. By multivariate analysis, cervical location of the tumour was found to be an independent factor of poor prognosis (relative risk= 3.1, 95% confidence interval= 1.3-7.8, P= 0.014).

CONCLUSION

Prognosis after surgical resection of cervical oesophagus carcinoma is very poor. Surgery in this location should be proposed in case of chemoradiation failure.