The role of lymph node is vital in the prognosis of esophageal carcinoma. This study is to explore the pattern of thoraco-abdominal two-field lymphatic metastasis.

613 patients with esophageal carcinoma visiting Qilu Hospital of Shandong University from Jan.2010 to Oct. 2016 were included in this study. The lymph node metastasis rate of each group was counted according to the standard of lymph node division of the Japan Esophageal Cancer Research Association (JEOG). Survival analysis was performed in 203 patients from Jan. 2010 to Oct. 2013.

Carcinoma of the upper thoracic esophagus mainly metastasized to mediastinal lymph nodes. The rates of metastasis to the left and right recurrent nerve lymph nodes were 35.9% and 40.7%, which were higher than that of middle-third and lower third of esophageal carcinoma. Carcinoma of the middle-third thoracic esophagus metastasized bidirectionally; and carcinoma of the lower-third thoracic esophagus mainly metastasized to the lymph nodes of the para-esophagus, lateral cardia and left gastric artery, among which the metastasis rate of left gastric artery was the highest. Univariate survival analysis showed that the lesion length, the degree of tumor differentiation, the depth of tumor invasion and lymph node metastasis were prognostic factors of esophageal carcinoma patients(P< 0.05). Multivariate analysis by COX regression showed that the low degree of tumor differentiation and status of lymph node metastasis were independent risk factors affecting the prognosis of esophageal carcinoma(P< 0.05).

Thus, it was important to clear the lymph nodes of the bilateral recurrent laryngeal nerve and left gastric artery to improve the survival rate of patients with thoracic esophageal carcinoma.