Transthoracal partial resection or local excision of small esophageal carcinoma with a radical mediastinal lymphadenectomy--proposal of limited operation for postoperative quality of life.

BACKGROUND/AIMS: Controversy remains regarding which treatment should be employed for superficial esophageal cancer. The treatment modalities for such superficial cancers vary from a local excision, including an endoscopic mucosal resection (EMR) to an extended radical esophagectomy (three-field lymphadenectomy). In the current report, we proposed the use of either a transthoracal partial resection or local excision of the esophagus with a radical mediastinal lymphadenectomy for the patients with small superficial esophageal squamous cell carcinoma, in order to perform effective radical cancer surgery and maintain the quality of life (QOL) of the patients. METHODOLOGY: Surgical procedures: After thoracotomy and detaching of the esophagus from the surrounding tissues, the proximal and distal resection lines were determined by careful palpation of the clips within the esophagus which had been placed during the preoperative endoscopic examination. Thereafter, a mediastinal lymph node dissection, including the bilateral recurrent nerve nodes and paratracheal nodes, was performed. After this procedure, intrathoracic esophageal end-to-end anastomosis was performed in the ordinary manner. We performed this procedure on three patients with small localized esophageal cancer. RESULTS: Operations were safely performed on these three patients and postoperative quality of life was almost satisfactory. CONCLUSIONS: Transthoracal partial resection or local excision with a radical mediastinal lymphadenectomy was useful for the patients with small localized esophageal carcinoma.