The Study On Lymph Node Metastasis Of Middle And Lower Thoracic Esophageal Carcinoma

Objective: Most patients of esophageal carcinoma are in their late stage when they seek for cure. Both of the rates of lymph node metastasis and recurrence are high. The prognosis of esophageal carcinoma is not so good. So far, surgical resection is still the most important treatment. But there is a great controversy in the extent of esophageal lymph node dissection. This article is to discuss the patterns of lymph node metastasis of middle and lower thoracic esophageal carcinoma,and provide the basis for the rational choice in the extent of lymph node dissection and postoperative combined treatment.Method: Clinical data of 49 patients with middle and lower thoracic esophageal carcinoma were analysed retrospectively. All of the patients had been operated through the left thoracic incision in the second affiliated hospital of shantou university medical college from January 2009 to May 2011. The diagnose of the patients with middle and lower thoracic esophageal carcinoma were confirmed by esophageal swallow barium imaging and gastroscope. There were not chemotherapy and radiotherapy for patients before operation. The procedure of esophagogastrectomy were include portion of esophagus to be resected, high intrathoracic esophagogastric anastomosis and lymph node dissections of middle-inferior mediastinum and abdomen. Some of them had been dissected lymph node of superior mediastinum (including the paraesophageal lymph nodes of the posterior and superior aortic arch, nearby azygos vein). All data were analysed with SPSS13.0 statistical packages for Windows.Results: Lymph node metastases were found in 24 of 49 patients(48.97%). All of the lymph nodes dissected were 871, the metastatic lymph nodes were 107. The rate of lymph node metastasis was 12.28%. Each patient was dissected 17.75 lymph node averagely. Middle and lower thoracic esophageal carcinoma can be transfered to the lymph nodes of thorax or abdomen. Skip metastasis is one of the characteristics of esophageal carcinoma. The deeper esophageal tumor infiltrated and the poorer tumor cell differentiated, the higher the rate of lymph node metastasis were(P<0.05). Conclusions: Lymph node metastasis of middle and lower thoracic esophageal carcinoma follows certain patterns. The rate of lymph node metastasis is significantly correlated to the differentiation of tumor cells and depth of of the tumor invasion, and not correlated to the gender, age and length of the tumor. Lymph node metastasis is closely related with prognosis of esophageal carcinoma. Lymph node dissection should be performed strictly within the drainage area of esophageal carcinoma.