Anatomical basis for the approach and extent of surgical treatment of esophageal cancer*

The surgical treatment of cancer of the esophagus includes esophagectomy, adequate radical lymphadenectomy, and esophageal reconstruction. Lymph node metastasis of esophageal cancer is the major factor that influences the prognosis after surgery. Even with an invasion depth limited to the mucosa or submucosa, the prognosis is remarkably poor compared with the same invasion depth in gastric or colorectal cancer. Superficial cancer of the esophagus may metastasize into lymph nodes far distant from the primary tumor, not only into the mediastinum but also into the neck and abdomen. Therefore, these cases require treatment of potentially widely distributed metastases and a safe construction of a viable intestinoesophageal conduit. Under the prevailing conditions, however, surgical interventions without fundamental knowledge of the structures of this area are unacceptable.