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Mitsuo Tachibana, MD; Shoichi Kinugasa, MD; Hiroshi Yoshimura, MD; Dipok Kumar Dhar, MD; Naofumi Nagasue, MD

Arch Surg. 2003;138:1383-1389.

Objective  To review the surgical outcomes of extended esophagectomy with 3-field lymph node dissection (3FLND) for esophageal cancer.

Data Sources  Only articles written in English and written after 1980 were selected from MEDLINE. The following terms were identified: 3FLND, extensive or extended lymph node dissection (lymphadenectomy), radical lymph node dissection, cervical lymph node dissection, and extended or radical esophagectomy in esophageal cancer.

Study Selection  There were no exclusion criteria for published information relevant to the topic. The most representative articles were selected when there were several articles from the same institution. Case reports were excluded.

Data Extraction  Twenty-six articles were finally col-lected from MEDLINE. Eleven articles were also selected from reference lists of the pertinent literature.

Data Synthesis  The collected information was organized.

Conclusions  The conclusions drawn from those articles showed that extended esophagectomy with 3FLND would be a safe procedure in experienced hands, with low morbidity and acceptable mortality rates. When strict patient selection criteria were maintained, this procedure reduced locoregional recurrence and improved long-term survival rates. Although the therapeutic value of 3FLND is unproved in a randomized trial, extended esophagectomy with 3FLND would be the treatment of choice in selected patients.

From the Second Department of Surgery, Shimane Medical University, Shimane, Japan.

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