Skip to main content

Controversial Issues in Esophageal Cancer: Surgical Approach and Lymphadenectomy

  • Chapter
Treatment of Esophageal and Hypopharyngeal Squamous Cell Carcinoma

Part of the book series: Updates in Surgery ((UPDATESSURG))

Abstract

Surgery is still the mainstay in the curative treatment of resectable esophageal cancer. Nevertheless, controversies and debate exist about the optimal management in terms of surgical approach, extent of resection, location of the anastomosis, and optimal nodal dissection. Moreover, the correct role of multimodal treatments, whose use is constantly increasing, has still to be defined, as well as their impact on surgical approach and lymphadenectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Law S (2009) Surgery techniques: anastomotic technique and selection of location In: Blair A. Jobe CRT, Jr, John G. Hunter (ed) Esophageal cancer principles and practice. Demos Medical, New York, pp 525–534

    Google Scholar 

  2. Lam KY, Ma LT, Wong J (1996) Measurement of extent of spread of oesophageal squamous carcinoma by serial sectioning. J Clin Pathol 49:124–129

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Tsutsui S, Kuwano H, Watanabe M et al (1995) Resection margin for squamous cell carcinoma of the esophagus. Ann Surg 222:193–202

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Law S, Arcilla C, Chu KM, Wong J (1998) The significance of histologically infiltrated resection margin after esophagectomy for esophageal cancer. Am J Surg 176:286–290

    Article  CAS  PubMed  Google Scholar 

  5. Kuwano H, Masuda N, Kato H, Sugimachi K (2002) The subepithelial extension of esophageal carcinoma for determining the resection margin during esophagectomy: a serial histopathologic investigation. Surgery 131:14–21

    Article  Google Scholar 

  6. Casson AG, Darnton SJ, Subramanian S, Hiller L (2000) What is the optimal distal resection margin for esophageal carcinoma? Ann Thorac Surg 69:205–209

    Article  CAS  PubMed  Google Scholar 

  7. Chao YK, Yeh CJ, Chang HK et al (2011) Impact of circumferential resection margin distance on locoregional recurrence and survival after chemoradiotherapy in esophageal squamous cell carcinoma. Ann Surg Oncol 18:529–534

    Article  PubMed  Google Scholar 

  8. Deeter M, Dorer R, Kuppusamy MK et al (2009) Assessment of criteria and clinical significance of circumferential resection margins in esophageal cancer. Arch Surg 144:618–624

    Article  PubMed  Google Scholar 

  9. Scheepers JJ, van der Peet DL, Veenhof AA, Cuesta MA (2009) Influence of circumferential resection margin on prognosis in distal esophageal and gastroesophageal cancer approached through the transhiatal route. Dis Esophagus 22:42–48

    Article  CAS  PubMed  Google Scholar 

  10. Sujendran V, Wheeler J, Baron R et al (2008) Effect of neoadjuvant chemotherapy on circumferential margin positivity and its impact on prognosis in patients with resectable oesophageal cancer. Br J Surg 95:191–194

    Article  CAS  PubMed  Google Scholar 

  11. Saha AK, Sutton C, Rotimi O et al (2009) Neoadjuvant chemotherapy and surgery for esophageal adenocarcinoma: prognostic value of circumferential resection margin and stratification of N1 category. Ann Surg Oncol 16:1364–1370

    Article  PubMed  Google Scholar 

  12. Griffiths EA, Brummell Z, Gorthi G et al (2006) The prognostic value of circumferential resection margin involvement in oesophageal malignancy. Eur J Surg Oncol 32:413–419

    Article  CAS  PubMed  Google Scholar 

  13. Pultrum BB, Honing J, Smit JK et al (2010) A critical appraisal of circumferential resection margins in esophageal carcinoma. Ann Surg Oncol 17:812–820

    Article  PubMed Central  PubMed  Google Scholar 

  14. Dexter SP, Sue-Ling H, McMahon MJ et al (2001) Circumferential resection margin involvement: an independent predictor of survival following surgery for oesophageal cancer. Gut 48:667–670

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Khan OA, Fitzgerald JJ, Soomro I et al (2003) Prognostic significance of circumferential resection margin involvement following oesophagectomy for cancer. Br J Cancer 88:1549–1552

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Shimada H, Okazumi S, Matsubara H et al (2006) Impact of the number and extent of positive lymph nodes in 200 patients with thoracic esophageal squamous cell carcinoma after threefield lymph node dissection. World J Surg 30:1441–1449

    Article  PubMed  Google Scholar 

  17. Peyre CG, Hagen JA, DeMeester SR et al (2008) Predicting systemic disease in patients with esophageal cancer after esophagectomy: a multinational study on the significance of the number of involved lymph nodes. Ann Surg 248:979–985

    Article  PubMed  Google Scholar 

  18. Liu YP, Ma L, Wang SJ et al (2010) Prognostic value of lymph node metastases and lymph node ratio in esophageal squamous cell carcinoma. Eur J Surg Oncol 36:155–159

    Article  CAS  PubMed  Google Scholar 

  19. Mariette C, Piessen G, Briez N, Triboulet JP (2008) The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg 247:365–371

    Article  PubMed  Google Scholar 

  20. Kelty CJ, Kennedy CW, Falk GL (2010) Ratio of metastatic lymph nodes to total number of nodes resected is prognostic for survival in esophageal carcinoma. J Thorac Oncol 5: 1467–1471

    Article  PubMed  Google Scholar 

  21. Hsu WH, Hsu PK, Hsieh CC et al (2009) The metastatic lymph node number and ratio are independent prognostic factors in esophageal cancer. J Gastrointest Surg 13:1913–1920

    Article  PubMed  Google Scholar 

  22. Rizk NP, Ishwaran H, Rice TW et al (2010) Optimum lymphadenectomy for esophageal cancer. Ann Surg 251:46–50

    Article  PubMed  Google Scholar 

  23. Altorki NK, Zhou XK, Stiles B et al M (2008) Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg 248:221–226

    Article  PubMed  Google Scholar 

  24. Peyre CG, Hagen JA, DeMeester SR et al (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248:549–556

    Article  PubMed  Google Scholar 

  25. Herrera LJ (2010) Extent of lymphadenectomy in esophageal cancer: how many lymph nodes is enough? Ann Surg Oncol 17:676–678

    Article  PubMed Central  PubMed  Google Scholar 

  26. Hu Y, Hu C, Zhang H et al (2010) How does the number of resected lymph nodes influence TNM staging and prognosis for esophageal carcinoma? Ann Surg Oncol 17:784–790

    Article  PubMed  Google Scholar 

  27. Groth SS, Virnig BA, Whitson BA et al (2010) Determination of the minimum number of lymph nodes to examine to maximize survival in patients with esophageal carcinoma: data from the Surveillance Epidemiology and End Results database. J Thorac Cardiovasc Surg 139:612–620

    Article  PubMed  Google Scholar 

  28. Tachimori Y, Nagai Y, Kanamori N et al (2011) Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system. Dis Esophagus 24:33–38

    Article  CAS  PubMed  Google Scholar 

  29. Smit JK, Pultrum BB, van Dullemen HM et al (2010) Prognostic factors and patterns of recurrence in esophageal cancer assert arguments for extended two-field transthoracic esophagectomy. Am J Surg 200:446–453

    Article  PubMed  Google Scholar 

  30. Johansson J, DeMeester TR, Hagen JA (2004) En bloc vs transhiatal esophagectomy for stage T3 N1 adenocarcinoma of the distal esophagus. Arch Surg 139:627–631

    Article  PubMed  Google Scholar 

  31. Omloo JM, Lagarde SM, Hulscher JB (2007) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 246:992–1000

    Article  PubMed  Google Scholar 

  32. Twine CP, Lewis WG, Morgan MA (2009) The assessment of prognosis of surgically resected oesophageal cancer is dependent on the number of lymph nodes examined pathologically. Histopathology 55:46–52

    Article  PubMed  Google Scholar 

  33. Schwarz RE, Smith DD (2007) Clinical impact of lymphadenectomy extent in resectable esophageal cancer. J Gastrointest Surg 11:1384–1393

    Article  PubMed  Google Scholar 

  34. Bollschweiler E, Besch S, Drebber U (2010) Influence of neoadjuvant chemoradiation on the number and size of analyzed lymph nodes in esophageal cancer. Ann Surg Oncol 17:3187–3194

    Article  PubMed  Google Scholar 

  35. Jamieson GG, Lamb PJ, Thompson SK (2009) The role of lymphadenectomy in esophageal cancer. Ann Surg 250:206–209

    Article  PubMed  Google Scholar 

  36. Qubain SW, Natsugoe S, Matsumoto M (2001) Micrometastases in the cervical lymph nodes in esophageal squamous cell carcinoma. Dis Esophagus 14:143–148

    Article  CAS  PubMed  Google Scholar 

  37. Tachibana M, Kinugasa S, Hirahara N, Yoshimura H (2008) Lymph node classification of esophageal squamous cell carcinoma and adenocarcinoma. Eur J Cardiothorac Surg 34:427–431

    Article  PubMed  Google Scholar 

  38. Kuge K, Murakami G, Mizobuchi S et al (2003) Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus. J Thorac Cardiovasc Surg 125:1343–1349

    Article  PubMed  Google Scholar 

  39. Chen J, Liu S, Pan J et al (2009) The pattern and prevalence of lymphatic spread in thoracic oesophageal squamous cell carcinoma. Eur J Cardiothorac Surg 36:480–486

    Article  PubMed  Google Scholar 

  40. Motoyama S, Maruyama K, Sato Y et al (2009) Status of involved lymph nodes and direction of metastatic lymphatic flow between submucosal and t2-4 thoracic squamous cell esophageal cancers. World J Surg 33:512–517

    Article  PubMed  Google Scholar 

  41. Nakagawa S, Nishimaki T, Kosugi S et al (2003) Cervical lymphadenectomy is beneficial for patients with carcinoma of the upper and mid-thoracic esophagus. Dis Esophagus 16:4–8

    Article  CAS  PubMed  Google Scholar 

  42. Lerut T, Nafteux P, Moons J et al (2004) Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, diseasefree survival, and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg 240:962–972

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Tachibana M, Hirahara N, Kinugasa S, Yoshimura H (2008) Clinicopathologic features of superficial esophageal cancer: results of consecutive 100 patients. Ann Surg Oncol 15:104–116

    Article  PubMed  Google Scholar 

  44. Mariette C, Piessen G, Balon JM et al (2004) Surgery alone in the curative treatment of localised oesophageal carcinoma. Eur J Surg Oncol 30:869–876

    Article  CAS  PubMed  Google Scholar 

  45. Ancona E, Rampado S, Cassaro M et al (2008) Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol 15:3278–3288

    Article  PubMed  Google Scholar 

  46. Altorki N, Kent M, Ferrara C, Port J (2002) Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg 236:177–183

    Article  PubMed Central  PubMed  Google Scholar 

  47. Prenzel KL, Bollschweiler E, Schroder W et al (2010) Prognostic relevance of skip metastases in esophageal cancer. Ann Thorac Surg 90:1662–1667

    Article  PubMed  Google Scholar 

  48. Fumagalli U, Akiyama H, DeMeester T (1996) Resective Surgery for Cancer of the Thoracic Esophagus: Results of a Consensus Conference held at the VIth World Congress of the International Society for Diseases of the Esophagus. Diseases of the Esophagus 9:30–38

    Google Scholar 

  49. Fujita H, Sueyoshi S, Tanaka T et al (2003) Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus: comparing the short-and long-term outcome among the four types of lymphadenectomy. World J Surg 27:571–579

    Article  PubMed  Google Scholar 

  50. Altorki N (2005) En-bloc esophagectomy-the three-field dissection. In: Landreneau RJ, Martin RF (eds) Esophageal surgery, vol 85. Elsevier-Surgical Clinics of North America, pp 611–619

    Google Scholar 

  51. Tachibana M, Kinugasa S, Yoshimura H et al (2004) En-bloc esophagectomy for esophageal cancer. Am J Surg 188:254–260

    Article  PubMed  Google Scholar 

  52. Fang W, Kato H, Tachimori Y et al (2003) Analysis of pulmonary complications after threefield lymph node dissection for esophageal cancer. Ann Thorac Surg 76:903–908

    Article  PubMed  Google Scholar 

  53. Tachibana M, Kinugasa S, Yoshimura H (2005) Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma. Am J Surg 189:98–109

    Article  PubMed  Google Scholar 

  54. Fang WT, Chen WH, Chen Y, Jiang Y (2007) Selective three-field lymphadenectomy for thoracic esophageal squamous carcinoma. Dis Esophagus 20:206–211

    Article  PubMed  Google Scholar 

  55. Shim YM, Kim HK, Kim K (2010) Comparison of survival and recurrence pattern between two-field and three-field lymph node dissections for upper thoracic esophageal squamous cell carcinoma. J Thorac Oncol 5:707–712

    Article  PubMed  Google Scholar 

  56. Igaki H, Tachimori Y, Kato H (2004) Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg 239:483–490

    Article  PubMed Central  PubMed  Google Scholar 

  57. Nishihira T, Hirayama K, Mori S (1998) A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 175:47–51

    Article  CAS  PubMed  Google Scholar 

  58. Law S, Wong J (2001) Two-field dissection is enough for esophageal cancer. Dis Esophagus 14:98–103

    Article  CAS  PubMed  Google Scholar 

  59. Nozoe T, Kakeji Y, Baba H, Maehara Y (2005) Two-field lymph-node dissection may be enough to treat patients with submucosal squamous cell carcinoma of the thoracic esophagus. Dis Esophagus 18:226–229

    Article  CAS  PubMed  Google Scholar 

  60. Shimada H, Okazumi S, Shiratori T et al (2009) Mode of lymphadenectomy and surgical outcome of upper thoracic esophageal squamous cell carcinoma. J Gastrointest Surg 13:619–625

    Article  PubMed  Google Scholar 

  61. Griffith JF, Chan AC, Ahuja AT et al (2000) Neck ultrasound in staging squamous oesophageal carcinoma-a high yield technique. Clin Radiol 55:696–701

    Article  CAS  PubMed  Google Scholar 

  62. van Vliet EP, van der Lugt A, Kuipers EJ (2007) Ultrasound, computed tomography, or the combination for the detection of supraclavicular lymph nodes in patients with esophageal or gastric cardia cancer: a comparative study. J Surg Oncol 96:200–206

    Article  PubMed  Google Scholar 

  63. Natsugoe S, Matsumoto M, Okumura H (2010) Clinical course and outcome after esophagectomy with three-field lymphadenectomy in esophageal cancer. Langenbecks Arch Surg 395:341–346

    Article  PubMed  Google Scholar 

  64. Tachibana M, Kinugasa S, Yoshimura H et al (2003) Extended esophagectomy with 3-field lymph node dissection for esophageal cancer. Arch Surg 138:1383–1389

    Article  PubMed  Google Scholar 

  65. Tabira Y, Yasunaga M, Tanaka M et al (2000) Recurrent nerve nodal involvement is associated with cervical nodal metastasis in thoracic esophageal carcinoma. J Am Coll Surg 191:232–237

    Article  CAS  PubMed  Google Scholar 

  66. Shiozaki H, Yano M, Tsujinaka T et al (2001) Lymph node metastasis along the recurrent nerve chain is an indication for cervical lymph node dissection in thoracic esophageal cancer. Dis Esophagus 14:191–196

    Article  CAS  PubMed  Google Scholar 

  67. Sato F, Shimada Y, Li Z et al (2002) Paratracheal lymph node metastasis is associated with cervical lymph node metastasis in patients with thoracic esophageal squamous cell carcinoma. Ann Surg Oncol 9:65–70

    Article  PubMed  Google Scholar 

  68. Puli SR, Reddy JB, Bechtold ML et al (2008) Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review. World J Gastroenterol 14:1479–1490

    Article  PubMed Central  PubMed  Google Scholar 

  69. Chang AC, Ji H, Birkmeyer NJ et al (2008) Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg 85:424–429

    Article  PubMed  Google Scholar 

  70. Barreto JC, Posner MC (2010) Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol 16:3804–3810

    Article  PubMed Central  PubMed  Google Scholar 

  71. Connors RC, Reuben BC, Neumayer LA, Bull DA (2007) Comparing outcomes after transthoracic and transhiatal esophagectomy: a 5-year prospective cohort of 17,395 patients. J Am Coll Surg 205:735–740

    Article  PubMed  Google Scholar 

  72. Junginger T, Gockel I, Heckhoff S (2006) A comparison of transhiatal and transthoracic resections on the prognosis in patients with squamous cell carcinoma of the esophagus. Eur J Surg Oncol 32:749–755

    Article  CAS  PubMed  Google Scholar 

  73. Rentz J, Bull D, Harpole D (2003) Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients. J Thorac Cardiovasc Surg 125:1114–1120

    Article  PubMed  Google Scholar 

  74. Wolff CS, Castillo SF, Larson DR (2008) Ivor Lewis approach is superior to transhiatal approach in retrieval of lymph nodes at esophagectomy. Dis Esophagus 21:328–333

    Article  CAS  PubMed  Google Scholar 

  75. Yekebas EF, Schurr PG, Kaifi JT et al (2006) Effectiveness of radical en-bloc-esophagectomy compared to transhiatal esophagectomy in squamous cell cancer of the esophagus is influenced by nodal micrometastases. J Surg Oncol 93:541–549

    Article  PubMed  Google Scholar 

  76. Grotenhuis BA, van Heijl M, Zehetner J (2010) Surgical management of submucosal esophageal cancer: extended or regional lymphadenectomy? Ann Surg 252:823–830

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Italia

About this chapter

Cite this chapter

de Manzoni, G., Zanoni, A., Giacopuzzi, S. (2012). Controversial Issues in Esophageal Cancer: Surgical Approach and Lymphadenectomy. In: de Manzoni, G. (eds) Treatment of Esophageal and Hypopharyngeal Squamous Cell Carcinoma. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-2330-7_13

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2330-7_13

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2329-1

  • Online ISBN: 978-88-470-2330-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics