Akiyama et al studied lymph node involvement in patients with carcinoma of the esophagus. Metastases to lymph nodes can be widespread irregardless of the tumor location. The authors are from Toranomon Hospital in Tokeyo.
Metastases along lymphatics is not segmental but rather longitudinal. Cancers of the upper esophagus can have positive lymph nodes below the diaphragm. Cancers of the distal esophagus can drain to the superior mediastinum.
Lymph nodes in the superior mediastinum:
(1) innominate artery
(2) paraesophageal
(3) paratracheal
(4) around the ligamentum arteriosum (Botallo)
Lymph nodes in middle mediastinum:
(1) tracheobronchial
(2) paraesophageal
(3) pulmonary hilar
Lymph nodes in the lower mediastinum:
(1) paraesophageal
(2) diaphragmatic
Lymph nodes below the diaphragm:
(1) paracardiac (superior gastric)
(2) lesser curvature
(3) left gastric artery
(4) celiac axis
(5) common hepatic artery
(6) splenic artery
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