Should en bloc esophagectomy be the standard of care for esophageal carcinoma?

Objective To determine the impact of radical node dissection on the recurrence patterns and survival rates of patients with carcinoma of the esophagus. Summary Background Data The role of esophagectomy with radical lymphadenectomy in the treatment of esophageal cancer is controversial. Most centers favor a limited operation with no attempt at nodal clearance. However, disease recurrence and patient survival rates remain dismal with or without preoperative therapy. The authors postulate that a more radical node dissection would reduce local failure rates and enhance survival. Methods One hundred eleven patients with esophageal cancer underwent en bloc esophagectomy with radical lymph node dissection between 1988 and 1998. In 90% of patients the procedure was applied nonselectively and without any preoperative therapy. Patients were prospectively followed up for recurrence patterns and survival. Results The 5-year survival rate including noncancer deaths was 40%. The 5-year survival rates for patients with stage 1, 2A, 2B, 3, and 4 disease were 78%, 72%, 0%, 39%, and 27%, respectively. Forty percent of patients had node-negative disease (5-year survival rate, 75%), and 60% had nodal metastases (5-year survival rate, 26%). Recurrence occurred in 39% of patients and was local in only 8%. Conclusions Radical esophagectomy results in superior overall and stage-specific 5-year survival rates, Extensive node dissection has a positive impact on survival rates, particularly in patients with nodal metastases.