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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2018

Open Access 01-05-2018 | Gastrointestinal Oncology

Elucidation of the Anatomical Mechanism of Nodal Skip Metastasis in Superficial Thoracic Esophageal Squamous Cell Carcinoma

Authors: Yuji Kumakura, MD, Takehiko Yokobori, MD, PhD, Tomonori Yoshida, MD, Keigo Hara, MD, Makoto Sakai, MD, PhD, Makoto Sohda, MD, PhD, Tatsuya Miyazaki, MD, PhD, Hideaki Yokoo, MD, PhD, Tadashi Handa, MS, Tetsunari Oyama, MD, PhD, Hiroshi Yorifuji, MD, PhD, Hiroyuki Kuwano, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2018

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Abstract

Background

Lymph node metastasis (LNM) is a standard mechanism of cancer progression in esophageal squamous cell carcinoma (ESCC). We aimed to clarify the anatomical mechanism of skip nodal metastasis to mediastinal zones by analyzing the relationship between LNM to sentinel zones and lymphatic vessel counts in the muscle layer adjacent to the outer esophagus.

Methods

We examined the surgical records of 287 patients with ESCC who underwent potentially curative surgery (three-field lymphadenectomy) and whole esophagi, including pharynges and stomachs from 10 cadavers, to determine the number of lymphatic vessels in the intra-outer longitudinal muscle layer adjacent to the outer esophagus of the cervical (Ce), upper thoracic, middle thoracic (Mt), lower thoracic (Lt), and abdominal esophagi (Ae).

Results

The frequency of LNM to the middle mediastinal and supraclavicular zones, including the Mt and Ce, respectively, was lower than to the upper and lower mediastinal and abdominal zone in patients with superficial and advanced thoracic ESCC. In cadavers, the lymphatic vessel counts of the intra-outer longitudinal muscle layer in the Mt and Ce were significantly lower than those of the Lt and Ae, suggesting that lymphatic flow toward the outside of the Mt and Ce was not more abundant than to other sites.

Conclusion

Our anatomical data suggested that the absence of intra-muscle lymphatic vessels in the middle mediastinal and supraclavicular zones causes skip LNM in patients with thoracic ESCC. Thus, standard esophagectomy with lymph node dissection, including distant zones, may be appropriate for treating patients with superficial thoracic ESCC.
Appendix
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Metadata
Title
Elucidation of the Anatomical Mechanism of Nodal Skip Metastasis in Superficial Thoracic Esophageal Squamous Cell Carcinoma
Authors
Yuji Kumakura, MD
Takehiko Yokobori, MD, PhD
Tomonori Yoshida, MD
Keigo Hara, MD
Makoto Sakai, MD, PhD
Makoto Sohda, MD, PhD
Tatsuya Miyazaki, MD, PhD
Hideaki Yokoo, MD, PhD
Tadashi Handa, MS
Tetsunari Oyama, MD, PhD
Hiroshi Yorifuji, MD, PhD
Hiroyuki Kuwano, MD, PhD
Publication date
01-05-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6390-0

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