Clinical Analysis of Metastasis Discipline in Superior Mediastinum Lymph Node of Thoracic Esophageal Carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CUIYue ^1,2 , XIETian-peng ² , YANGXiao-jun ² , XIANGRun ¹ ,  LIQiang ^1,2

1. Graduate School of Guangxi Medical University, Nanning 530021, P. R. China;
2. Department of Thoracic Surgery, The Second People's Hospital of Sichuan, Chengdu 610041, P. R. China;

Corresponding?author：

LIQiang, Email: liqiang201320@163.com

Keywords：

Esophagealcarcinoma; Lymph node metastasis; Superior mediastinum

DOI：

10.7507/1007-4848.20150255

Video：

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Objective To explore the discipline of superior mediastinum lymph node metastasis of esophageal carcinoma, laying a foundation for the standardization of lymphadenectomy. Methods We retrospectively analyzed the clinical data of 586 patients with esophageal carcinoma in our hospital between June 2009 and June 2014. There were 489 males and 97 females at age of 61.61±7.92 years. We analyzed the discipline of lymph node metastasis in these patients. Results The mean number of lymph nodes dissection was 20.48±11.01 per patient. A total of 1 212 lymph nodes metastasis was found in 326 patients (55.63%). The ratio of lymph nodes metastasis in the superior mediastinum, lower mediastinum, and abdominal cavity was 29.35%, 25.94%, and 31.74% respectively with no statistical difference among the three groups (χ²=4.839, P=0.089). In regard to upper thoracic esophageal carcinoma, the ratio of lymph nodes metastasis in the superior mediastinum, lower mediastinum, and abdominal cavity was 43.48%, 3.73%, and 13.73% respectively with higher metastasis rate (χ²=32.692, P=0.000) in the upper mediastinum. In middle thoracic esophageal carcinoma patients, there was no statistical differences in the ratio of lymph node metastasis among upper mediastinum (28.19%), lower mediastinum (29.53%), and abdominal cavity (31.54%, χ²=0.566, P=0.753). While in the patients with the lower thoracic esophageal carcinoma, the ratio of lymph nodes metastasis in the superior mediastinum, lower mediastinum, and abdominal cavity was 22.92%, 27.08%, and 41.67%, respectively with higher ratio of lymph nodes metastasis in abdominal cavity (χ²=17.542, P=0.000). The involved ratio of the right recurrent lymph nodes (19.80%) was the highest among all the lymph nodes in the superior mediastinum (χ²=112.304, P=0.000). Conclusion Upper mediastinum is one of the predilection sites of lymph nodes metastasis of esophageal carcinoma, focusing on the resection of superior mediastinum lymph nodes, especially the right recurrent lymph nodes can decrease the chances of relapse by reducing residual tumor cells.

Citation： CUIYue, XIETian-peng, YANGXiao-jun, XIANGRun, LIQiang. Clinical Analysis of Metastasis Discipline in Superior Mediastinum Lymph Node of Thoracic Esophageal Carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1026-1030. doi: 10.7507/1007-4848.20150255 Copy

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2.	Tachibana M,Kinugasa S,Dhar DK,et al.Prognostic factors after extended esophagectomy for squamous cell carcinoma of the thoracic esophagus.J Surg Oncol,1999,72(2):88-93.
3.	Udagawa H,Akiyama H.Surgical treatment of esophageal cancer:Tokyo experience of the three-field technique.J Dis Esophagus,2001,14(2):110-114.
4.	Herbella FA,Del Grande JC,Colleoni R,et al.Anatomical analysis of the mediastinal lymph nodes of normal Brazilian subjects according to the classification of the Japanese Society for Diseases of the Esophagus.J Surg Today,2003,33(4):249-253.
5.	Lerut T,Nafteux P,Moons J,et al.Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 RO resection:impact on staging,disease-free survival and outcome:a plea for adaptation of TNM classification in upper-half esophageal carcinoma.J Ann Surg,2004,240(6):962-974.
6.	Liebermann-Meffert D.Anatomical basis for the approach and extent of surgical treatment of esophageal cancer.J Dis Esophagus,2001,14(2):81-84.
7.	Igaki H,Tachimori Y,Kato H.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.J Ann Surg,2004,239(4):483-490.
8.	Wu J,Chen QX,Zhou XM,et al.Does recurrent laryngeal nerve lymph node metastasis really affect the prognosis in node-positive patients with squamous cell carcinoma of the middle thoracic esophagus?.BMC Surg,2014,14-43.
9.	Hsu PK,Huang CS,Hsieh CC,et al.Role of right upper mediastinal lymph node metastasis in patients with esophageal squamous cell carcinoma after tri-incisional esophagectomies.Surg,2014,156(5):1269-77.
10.	Akiyama H,Tsurumaru M,Udagawa H,et al.Radical lymph node dissection for cancer of the thoracic esophagus.J Ann Surg,1994,220(3):364-373.
11.	Li B,Chen H,Xiang J,et al.Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma:a single-institution experience.J Thorac Cardiovasc Surg,2012,144(4):778-786.
12.	TachimoriY,NagaiY,Kanamori N,et al.Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system.J Diseases of the Esophagus,2011,24(1):33-38.
13.	周純武,石木蘭,李洪林.食管癌手術后CT掃描隨診的價值.中華放射學雜志,1995,29(9):608-609.
14.	劉冠,徐裕金,賴霄晶,等.111例胸段食管癌患者根治術后復發規律的探討田.腫瘤學雜志,2011,17(6):438-440.
15.	龐青松,章文成,王平.胸段食管癌根治術后復發規律的臨床研究.中國腫瘤臨床,2012,39(16):1236-1238.
16.	Tabira Y,Yasunaga M,Tanaka M,et al.Recurrent nerve nodal involvement is associated with cervical nodal metastasis in thoracic esophageal carcinoma.J Am Coll Surg,2000,191(3):232-237.
17.	Li H,Yang S,Zhang Y,et al.Thoracic Recurrent Laryngeal Lymph Node Metastases Predict Cervical Node Metastases and Benefit From Three-Field Dissection in Selected Patients With Thoracic Esophageal Squamous Cell Carcinoma.J Surg Oncol,2012,105(6):548-552.
18.	Lerut T,Coosemans W,De Leyn P,et al.Reflections on three field lymphadenectomy in carcinoma of the esophagus and gastroesophageal junction.Hepatogastroenterology,1999,46(26):717-25.
19.	Nishihira T,Hirayama JA,Mori S.A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus.Am J Surg,1998,175(1):47-51.
20.	Mizutani M,Murakami G,Nawata S,et al.Anatomy of right recurrent nerve node:why does early metastasis of esophageal cancer occur in it?.J Surg Radiol Anat,2006,28(4):333-338.
21.	Kuge K,Murakami G,Mizobuchi S,et al.Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus.J Thorac Cardiovasc Surg,2003,125(6):1343-1349.
22.	葉凱,許建華,許雙塔,等.胸段食管鱗癌喉返神經旁淋巴結轉移特點及臨床意義.中國腫瘤臨床,2008,32(17):980-983.
23.	Fujita H,Sueyoshi S,Tanaka T,et al.Three-field dissection for squamous cell carcinoma in the thoracic esophagus.J Ann Thorac Cardiovasc Surg,2002,8(6):328-335.
24.	Malassagne B,Tiret E,Duprez D,et al.Prognostic value of thoracic recurrent nerve nodal involvement in esophageal squamous cell carcinoma.J Am Coll Surg,1997,185(3):244-249.
25.	Vickery CW,Hollowood AD,Barham CP,et al.Investigating the proximal limit of lymphadenectomy in patients with adenocarcinoma of the oesophagus in the mid-thoracic region.Br J Surg,2000,87(3):362-373.

1. Nabil P,Hemant I,Thomas W,et al.Optimum lymphadenectomy for esophageal cancer.J Ann Surg,2010,251(1):46-50.
2. Tachibana M,Kinugasa S,Dhar DK,et al.Prognostic factors after extended esophagectomy for squamous cell carcinoma of the thoracic esophagus.J Surg Oncol,1999,72(2):88-93.
3. Udagawa H,Akiyama H.Surgical treatment of esophageal cancer:Tokyo experience of the three-field technique.J Dis Esophagus,2001,14(2):110-114.
4. Herbella FA,Del Grande JC,Colleoni R,et al.Anatomical analysis of the mediastinal lymph nodes of normal Brazilian subjects according to the classification of the Japanese Society for Diseases of the Esophagus.J Surg Today,2003,33(4):249-253.
5. Lerut T,Nafteux P,Moons J,et al.Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 RO resection:impact on staging,disease-free survival and outcome:a plea for adaptation of TNM classification in upper-half esophageal carcinoma.J Ann Surg,2004,240(6):962-974.
6. Liebermann-Meffert D.Anatomical basis for the approach and extent of surgical treatment of esophageal cancer.J Dis Esophagus,2001,14(2):81-84.
7. Igaki H,Tachimori Y,Kato H.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.J Ann Surg,2004,239(4):483-490.
8. Wu J,Chen QX,Zhou XM,et al.Does recurrent laryngeal nerve lymph node metastasis really affect the prognosis in node-positive patients with squamous cell carcinoma of the middle thoracic esophagus?.BMC Surg,2014,14-43.
9. Hsu PK,Huang CS,Hsieh CC,et al.Role of right upper mediastinal lymph node metastasis in patients with esophageal squamous cell carcinoma after tri-incisional esophagectomies.Surg,2014,156(5):1269-77.
10. Akiyama H,Tsurumaru M,Udagawa H,et al.Radical lymph node dissection for cancer of the thoracic esophagus.J Ann Surg,1994,220(3):364-373.
11. Li B,Chen H,Xiang J,et al.Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma:a single-institution experience.J Thorac Cardiovasc Surg,2012,144(4):778-786.
12. TachimoriY,NagaiY,Kanamori N,et al.Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system.J Diseases of the Esophagus,2011,24(1):33-38.
13. 周純武,石木蘭,李洪林.食管癌手術后CT掃描隨診的價值.中華放射學雜志,1995,29(9):608-609.
14. 劉冠,徐裕金,賴霄晶,等.111例胸段食管癌患者根治術后復發規律的探討田.腫瘤學雜志,2011,17(6):438-440.
15. 龐青松,章文成,王平.胸段食管癌根治術后復發規律的臨床研究.中國腫瘤臨床,2012,39(16):1236-1238.
16. Tabira Y,Yasunaga M,Tanaka M,et al.Recurrent nerve nodal involvement is associated with cervical nodal metastasis in thoracic esophageal carcinoma.J Am Coll Surg,2000,191(3):232-237.
17. Li H,Yang S,Zhang Y,et al.Thoracic Recurrent Laryngeal Lymph Node Metastases Predict Cervical Node Metastases and Benefit From Three-Field Dissection in Selected Patients With Thoracic Esophageal Squamous Cell Carcinoma.J Surg Oncol,2012,105(6):548-552.
18. Lerut T,Coosemans W,De Leyn P,et al.Reflections on three field lymphadenectomy in carcinoma of the esophagus and gastroesophageal junction.Hepatogastroenterology,1999,46(26):717-25.
19. Nishihira T,Hirayama JA,Mori S.A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus.Am J Surg,1998,175(1):47-51.
20. Mizutani M,Murakami G,Nawata S,et al.Anatomy of right recurrent nerve node:why does early metastasis of esophageal cancer occur in it?.J Surg Radiol Anat,2006,28(4):333-338.
21. Kuge K,Murakami G,Mizobuchi S,et al.Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus.J Thorac Cardiovasc Surg,2003,125(6):1343-1349.
22. 葉凱,許建華,許雙塔,等.胸段食管鱗癌喉返神經旁淋巴結轉移特點及臨床意義.中國腫瘤臨床,2008,32(17):980-983.
23. Fujita H,Sueyoshi S,Tanaka T,et al.Three-field dissection for squamous cell carcinoma in the thoracic esophagus.J Ann Thorac Cardiovasc Surg,2002,8(6):328-335.
24. Malassagne B,Tiret E,Duprez D,et al.Prognostic value of thoracic recurrent nerve nodal involvement in esophageal squamous cell carcinoma.J Am Coll Surg,1997,185(3):244-249.
25. Vickery CW,Hollowood AD,Barham CP,et al.Investigating the proximal limit of lymphadenectomy in patients with adenocarcinoma of the oesophagus in the mid-thoracic region.Br J Surg,2000,87(3):362-373.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Analysis of Metastasis Discipline in Superior Mediastinum Lymph Node of Thoracic Esophageal Carcinoma

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