Abstract:

Objective
 To explore the extent of lymph node dissection for upper and middle thoracic esophageal cancer by comparing the efficacy of three-field lymphadenectomy(3-FL) and two-field lymphadenectomy(2-FL). Methods 119 patients    who were treated surgically with upper and middle thoracic esophageal squamous carcinoma from 2008 to 2010 were retrospectively reviewed. 46 patients were treated by 3-FL(3-FL group), and the remain 73 patients were treated by 2-FL(2-FL group). Results The lymph node metastasis rate in 3-FL group(58.7%) was much higher
 than that in 2-FL group (39.7%), the difference was significant(P<0.05).The cervical lymph node metastasis rate in 3-FL group was 21.7%. The upper mediastinal lymph node metastasis rate in 3-FL group(28.2%) was much higher than that in 2-FL group(11.0%)(P<0.05). The surgical morbidity in 3-FL group(39.1%) was much higher than that in 2-FL group(16.4%, P<0.01), the main difference was the rate of recurrent laryngeal nerve palsy. The one-year survival rate of the patients in 3-FL group(95.6%) was higher than that in 2-FL group(83.5%)(P<0.01).
Conclusion Compared with 2-FL, 3-FL can dissect the cervical and upper mediastinal lymph nodes more thoroughly, reduce the local recurrence rate, and improve the rate of survival. The patients with upper and middle thoracic esophageal squamous carcinoma without metastasis should be operated by 3-FL.

Key words: esophageal squamous carcinoma；thre
e-field lymphadenectomy；two-field lymphadenectomy