From June 1987 to December 1994, 372 patients underwent operation for resection of esophageal cancer, and 48 patients with metastasis to distant abdominal lymph nodes were analyzed.
The primary tumors were located predominantly in lower thoracic esophagus(n=29). The location of involved lymph nodes were celiac L/N(n=45), common hepatic L/N(n=4), paraaortic L/N(n=1), and retropanoreatic L/N(n=1). Most tumors penetrated the
esophageal wall(T3, T4, n=43), metastased to regional L/N(N1, n=41), but a few tumors were limited to the esophageal wall(T1, T2, n=5), metastased to distant abdominal L/N without metastasis to regional L/N(N0, n=7). Resectability rate was
87.5%(42/48),
and complete resection was possible in 31 patients(64.6%). The most frequent cause of incomplete resection and unresectability was unresectable T4 lesions(n=8), extranodal invasion(n=7). Overall operative mortality and morbidity was 4.2%, 22.9%,
and
resection mortality was 4.8%. Adjuvant therapy was given to 27 patients, and postoperative follow-up was possible in all patients(median follow-up, 32 months). The l year and 3 year survival for resection group was 54.0%, 18.1%(median, 386 days)
including operative deaths.
Our results suggest that resection of the esophageal cancer with metastasis to distant abdominal lymph nodes(MILYN) can be done with acceptable mortality and morbidity, and may play a role in long-term survival in carefully selected patients
because
prognosis is dismal in unresectable esophageal cancer. We recommend that lymph nodes around celiac axis be dissected thoroughly for exact staging and possible prolongation of survival, and multimodality therapy as necessary because most patients
with
MI(LYN) esophageal cancer do poorly with only primay surgical treatment.
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