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Invited Critique
December 1, 2003

Extended Esophagectomy With 3-Field Lymph Node Dissection for Esophageal Cancer—Invited Critique

Arch Surg. 2003;138(12):1390. doi:10.1001/archsurg.138.12.1390

The treatment of esophageal cancer remains one of the most difficult for the thoracic surgeon and thoracic oncologist. The range of treatment options goes from simple stinting with palliation to chemoradiation therapy with or without surgery, and from minimally invasive surgical approaches to extended esophagectomy with radical lymph node dissection. The latter approach is summarized in the article by Tachibana et al.

In this article, the authors summarize the results of extended radical esophagectomy found in 37 manuscripts reported from 1980 to the present. They specifically looked at the degree of lymph node dissection and whether this was in 2 or 3 fields. Although they report a trend toward better survival in 3-field dissection, there was no statistical difference when 2- or 3-field dissection was compared in a prospective randomized trial. The concern raised with this more radical approach, however, is a very high complication rate (48.5%). The study is limited by the lack of data regarding the preoperative clinical and pathologic stages in these patients and how decisions were made in terms of which approach was used.

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