Clinical study on the pattern of lymphnode metastasis in carcinoma of esophagus (an analysis of 200 cases)

Objective: To study the pattern of lymphnode metastasis in carcinoma of esophagus. Methods: 200 cases of resected esophageal cancer specimens were carefully examined pathologically. Lymphnode metastasis, its pathway and extent in relation to pathological changes were analyzed. Results: Lymphnode metastasis was mainly regional and extended vertically in both directions. Leaping-over metastasis was another feature. The deeper invasion by the tumor, the higher frequencies of metastasis development, and vice versa. However, leaping-over metastasis was more likely to occur where tumor invasion was less severe. Conclusion: Owing to the high frequency of lymphnode metastasis in the superior mediastinum and the widely spanned leaping-over metastasis, an operative approach by three incisions through right thoracotomy with excision of the whole segment of esophagus and anastomosis at cervical region was recommended, in order to dissect lymphnodes in the cervical, thoracic and abdominal regions and to leave less or no metastatic lymphnodes behind.