BACKGROUND: To evaluate the indication, survival and prognostic factors of esophagogastrectomy with two-field lymphadenectomy in thoracic esophageal carcinoma. METHODS: From January 1990 to December 2001, 111 patients were retrospectively analyzed. There were 83 men and 29 women. Median age was 55,1 years (range 35-79). Partial( standard) mediastinal lymphadenectomy was performed in 34 patients (30,6%) and extended lymphadenectomy in 77(69,4%). RESULTS: The median number of dissected lymph node was 22,6(range 4-50). No residual disease(R0) was found in 53 patients(47,7%), microscopic residual disease(R1) in 57(52,3% and macroscopic residual disease(R2) in 1(0,9%). Recurrence occurred in 32 patients(28,8%): cervical in 7(6,3%), locoregional in 17(15,3%) and distant in 19(17,1%). Operative morbity and mortality were 31,55 and 9% respectively with no significant difference between partial(standard) and extended mediastinal lymphadenectomy. The overall 5-year survival rate was 48,4%, with no significant diference with respect to the extension of the mediastinal lymphadenectomy. However there was a significant diference in disease-free survival rate in favor of patientes who underwent extended mediastinal lymphadenectomy (0,01). No residual disease(RO), no regional lymph node involvement(pN0) and number of positive lymph node less than 4 were identified as good prognostic factors. CONCLUSION: The esophagogastrectomy with two-field lymphadenectomy had a positive impact in 5-year survival rate in patients with thoracic esophageal carcinoma particularly in ECIII patients. Extended mediastinal lymphadenectomy improved the disease-free survival.
Esophagectomy; Lymph node excision; Esophageal neoplasms; Thorax
