Published in:
01-07-2014 | Original Article
Should lymph nodes along the thoracic duct be dissected routinely in radical esophagectomy?
Published in: Esophagus | Issue 3/2014
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Background
Although dissection of mediastinal lymph nodes along the thoracic duct is included in standard radical esophagectomy, it is not routinely performed because of the undesirable hemodynamic effects. This study aims to investigate whether dissection of the nodes along the thoracic duct has prognostic benefits.
Methods
A total of 778 consecutive patients who underwent radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma of the thoracic esophagus from 1984 to 2011 were included. The incidence of metastasis in thoracic duct nodes and that in nodes within #112 station excluding thoracic duct nodes were studied in relation to the depth of the main tumor. The survival curves of lymph node-positive patients were compared.
Results
The metastatic incidence was 2.2 % in T1b/T2, whereas it was 10.0 % in T3/T4. The survival curves in patients with metastasis in the thoracic duct nodes and in the #112 station were not statistically different.
Conclusion
The dissection of the nodes along the thoracic duct along with thoracic duct resection should be performed routinely; however, reliable indicator of the necessity of its dissection is awaited in T1b/T2 tumors because of the low metastatic rate and the potential risk associated with resection of the thoracic duct.