Four Cases of Cervical Esophageal Cancer Causing Rouviere Lymph Node Metastases

Abstract

We have experienced four cases of retropharyngeal lymph node (Rouviere lymph node) metastasis after surgery for cervical esophageal cancer. The initial therapies for the cervical esophageal cancers were surgery in three cases and chemoradiotherapy (CRT) in the remaining one. Case 1 : The patient was found having Rouviere lymph node metastasis 2 months after the surgery. CRT for the metastasis was ineffective and the patient died 7 months after the surgery. Case 2 : The patient had solitary metastasis to the Rouviere lymph node 2 months after the surgery for the primary lesion. A complete response could be achieved by chemotherapy and the patient has been alive as of 5 years after the surgery. Case 3 : Metastasis to the right Rouviere lymph node alone occurred 43 months after the surgery for which CRT yielded a complete response. The patient has been alive as of 5 years after the surgery. Case 4 : The patient developed bilateral Rouviere lymph nodes metastases 8 months after the initial CRT, which were unresectable by salvage operation. The patient died 19 months after the initial CRT.
In the Japanese Classification of Esophageal Cancer, the Rouviere lymph nodes are not involved in the regional lymph nodes of cervical esophageal come, so that Rouviere lymph node metastasis should be considered as distant metastasis. However, favorable therapeutic results and long-term survival could be gained in two out of four cases in our series. We consider that early diagnosis of Rouviere lymph node metastasis and appropriate treatments are important.