Q What is radical esophagectomy?
A It includes both two field and three field esophagectomy
Two field esophagectomy
For tumors of the middle or lower thoracic esophagus, the en-bloc specimen would include, in addition to the tumor-bearing organ, the pericardium anteriorly
both pleural surfaces laterally, thoracic duct and all other lympho-areolar tissue wedged posteriorly between the esophagus and the spine.
Additionally, for tumors traversing the diaphragm, a 1-in cuff of diaphragm is excised circumferentially around the esophagus.
The associated two-field lymphadenectomy includes en-bloc resection of all nodal groups between the tracheal bifurcation superiorly to the celiac axis inferiorly.
Lymph node stations include
Periesophageal, parahiatal, subcarinal, and aortopulmonary window nodes.
In the abdomen, an upper abdominal and retroperitoneal node dissection is performed, and includes resection of the celiac, splenic, common hepatic, left gastric, lesser curvature, and parahiatal nodes
Three field esophagectomy
40% of patients who had resected squamous cell esophageal cancer developed isolated cervical lymph node metastases
The additional third field of dissection included excision of the nodes along both recurrent nerves as they course through the mediastinum and neck, as well as a modified cervical node dissection. The latter includes the nodes posterior and lateral to the internal jugular vein and an infraomohyoid node dissection bilaterally
There is substantial morbidity rates associated with three-field lymphadenectomy, recent research focuses on refining patient selection for this procedure. From mostly retrospective studies, it can be shown that survival advantage may not be demonstrable for lower-third tumors], for patients who have positive nodes in all three surgical fields where intramural metastases are present, or in those who have five or more involved nodes
