Total Oesophagectomy for Squamous Cell Carcinoma with or Without Standard Two Field Node Dissection - a Prospective Study

Cancer of the esophagus and gastroesophageal junction (GEJ) is notorious for its advanced stage at the time of diagnosis with transmural invasion and early lymphatic spread in the majority of the patients. R0 resection is the aim of surgery with curative intent. Regarding the role of lymphadenectomy, as in any other solid organ cancer, there are opposing views. Some surgeons argue that the presence of lymph node involvement equals systemic disease and that survival remains unchanged despite removal of these lymph nodes. For others the presence of lymph node involvement, even at a distance from the primary tumor, justifies an aggressive approach with radical esophagectomy combined with lymphadenectomy. The purpose of this article is to compare standard two field lymph node dissection versus non formal lymph node dissection in carcinoma esophagus. The conclusions are based on the experience with 60 cases of carcinoma esophagus over 2 years. In our opinion total esophagectomy with 2-field lymphadenectomy is the standard surgery for resectable squamous cell carcinoma of esophagus. It improves the lymphnode yield thereby ensuring adequate staging of the disease. It can be performed with acceptable morbidity and mortality as the nonformal lymphadenectomy procedure. Locoregional recurrence following 2 field lymphadenectomy is significantly low as compared to nonformal lymphadenectomy procedure though the distant recurrence rate is same. 2 year disease free survival in this study shows advantage of 2 field lymphadenectomy compared to non formal lymphadenectomy procedure.