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 mL, 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.