Abstract
Sugical procedures for thoracic esophageal cancer were classified into two categories; the standard esophagecotmy with thoracotomy and reduced surgery, i.e. esophagectomy without thoracotomy, endoscopic mucosal resection and thoracoscopy-assisted esophagectomy. The standard esophagectomy included subtotal esophagectomy and extended lymph node dissection in the mediastinum, abdomen and neck. This was indicated for stage I (TIB), stage II and stage III. Lymph node metastasis was found in the upper mediastinum most frequently, followed by the middle mediastinum and upper abdomen. In particular, systematic lymph node dissection in the upper mediastinum was most important. Pathological results for 204 cases of T1 cancer resected in our department, have shown mucosal and submucosal cancer in 102 cases each. The incidence of lymph node metastases was 2% in mucosal cancer cases, and 38% in submucosal cancer cases. Lymph node metastasis was observed in mucosal cancer with gross invasin to the muscularis mucosae. The indications for endoscopic mucosal resection of esophageal cancer were stage I (T1A) less than 2×2cm or less than one third of the circumference of the esophagus apart from gross invasion to the muscularis mucosae, without nodal involvement. The indications for transhiatal esophagectomy were as follows: stage I (T1A) more than 4cm in size or more than two thirds of the circumference of the esophagus or multiple mucosal lesions throughout the esophagus. The indications of thoracoscopy assisted esophagectomy were T1 and T2 cancer without multiple nodal involvements.
