Lymph node and perinodal tissue tumor involvement in patients with esophagectomy and three-field lymphadenectomy for carcinoma of the esophagus

Background: Lymph node metastasis is a definitive prognostic factor; however, perinodal fat tumor invasion has not been fully elucidated. Methods: Periesophageal nodes and the surrounding fibrofatty tissue obtained from 131 patients who underwent esophagectomy were examined. Results: Of 9,789 nodes removed, 645 (6.6%) demonstrated invasion and 143 (1.5%) showed perinodal involvement. Of 131 patients, 97 (74.0%) had lymph node involvement and 43 (32.8%) had perinodal fat involvement. The incidence of perinodal tissue involvement correlated significantly with the number of nodes involved; 23 (42.6%) of 54 patients with a total of 1-8 nodes involved and 19 (95.0%) of 20 patients with 9 or more involved nodes had perinodal involvement. The 5-year survival for 33 patients without involved nodes or perinodal tissue extension was 59.7%, compared to 14.0% for 43 patients with perinodal fat involvement. Conclusion: Perinodal tissue carcinoma into the periesophageal fibrofatty tissue was a decisive prognostic factor in patients with curative resection for esophageal carcinoma. (C) 1997 Wiley-Liss, Inc.