Extended radical esophagectomy for superficially invasive carcinoma of the esophagus

Background: The purpose of the study was to determine whether extended radical esophagectomy is both clinically and oncologically indicated for patients with superficially invasive esophageal carcinomas. Methods: We reviewed 51 patients with this disease in whom extended radical esophagectomy was performed. Results: Major morbidity developed in 80% of the patients associated with no mortality after the operation. At surgery lymph node metastases were found in 29 patients (57%). Although the number of positive nodes was 3 or less in 93% of those patients, the tumors metastasized not only to the mediastinal nodes but also to the cervical and abdominal nodes, frequently jumping the first echelon of nodes. The overall 5-year survival rate was 68%. The survival curve of the patients with positive nodes was significantly worse ( P < .01) than that of patients with negative nodes: the respective 5-year survival rates were 47% and 93%. However, no significant difference was detected between the survival curves of the patients with cervical metastases and those with noncervical metastases. Conclusions: Extended radical esophagectomy is needed for complete tumor clearance and may be effective in improving the rate of cure in patients with superficially invasive esophageal carcinoma. However, patients should be selected carefully for the performance of extended radical esophagectomy because this procedure is potentially associated with high morbidity rates. (Surgery 1999;125:142-7.)