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Japanese Journal of Clinical Oncology 2007 37(4):314-318; doi:10.1093/jjco/hym024
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© 2007 Foundation for Promotion of Cancer Research

Prognostic and Clinical Evaluation of Axillary Lymph Node Metastasis in Esophageal Cancer

Shuhei Komatsu1, Yuji Ueda1,, Daisuke Ichikawa1, Hitoshi Fujiwara1, Kazuma Okamoto1, Shojiro Kikuchi1, Atsushi Shiozaki1, Kenichiro Imura1, Rumi Ohsawa1, Toshiya Ochiai1, Takuji Tsubokura2 and Hisakazu Yamagishi1

1 Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
2 Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

For reprints and all correspondence: Yuji Ueda, Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. E-mail: yueda{at}koto.kpu-m.ac.jp

Received October 1, 2006; accepted December 6, 2006

Axillary lymph node metastasis (ALNM) from esophageal cancer is rare. Its prognosis and effective treatments remain unknown. Between 1997 and 2005, esophagectomy was performed in 361 patients with esophageal cancer in our hospital. ALNM was identified in four patients (1.1%). All patients had left ALNM with ipsilateral left supraclavicular lymph node metastasis. In two patients ALNM developed after radical esophagectomy with regional lymphadenectomy and in the other two patients after chemoradiotherapy of primary lesions. Axillary lymphadenectomy with chemoradiotherapy was given to all patients. Median survival time and disease-free survival (DFS) after initial treatment for primary esophageal cancer were 30.5 months and 11.5 months, respectively. One patient, who had a small number of regional lymph node metastases (two lymph nodes) at esophagectomy and prolonged DFS (22 months) until axillary node recurrence, is still alive, 67 months after axillary lymphadenectomy. The other three patients, who had larger numbers of regional lymph node metastases (average, 8.3) and shorter DFS (average, 9.7 months), died of recurrence an average of 13.3 months after axillary lymphadenectomy. In conclusion, although ALNM is considered a type of distant organ metastasis, if it is a solitary recurrence, good survival may be obtained after appropriate loco-regional therapy. The number of metastatic regional lymph nodes at initial esophagectomy and the duration of DFS until axillary node recurrence can help to guide the decision whether aggressive treatments are warranted.

Key Words: esophageal cancer • lymph node metastasis • axillary lymph node • salvage surgery • prognosis


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