A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus

BACKGROUND: Recurrence of thoracic esophageal carcinoma in the cervical and superior mediastinal lymph nodes occurs frequently and contributes to a poor prognosis, Extensive lymphadenectomy has been advocated, Findings in support of this to date, however, have been based on a comparison with historical controls, We herein report a prospective randomized trial of extended and conventional lymphadenectomy. METHODS: Cases of thoracic esophageal carcinoma meeting criteria predictive of complete resection were randomized into conventional and extended cervical and superior mediastinal lymphadenectomy groups, RESULTS: In the extended and conventional lymphadenectomy groups, respectively, mean operative time was 487 +/- 47 and 396 +/- 43 minutes, blood loss was 850 +/- 429 and 576 +/- 261 mt, node count was 82 +/- 22 and 43 +/- 15, hospital deaths occurred in 3% and 7%, 2-year survival was 83.3% and 64.8%, 5-year survival was 66.2% and 48.0%, and recurrence rate was 19.9% and 24.1%. CONCLUSION: Extended lymphadenectomy may prevent recurrence and prolong survival after resection of thoracic esophageal carcinoma. (C) 1998 by Excerpta Medica, Inc.