Assessing the outcomes of posterior thoracic para-aortic lymph node lymphadenectomy after induction chemotherapy in patients with esophageal squamous cell carcinoma

Abstract

Background: Posterior thoracic para-aortic lymph node (TPAN) metastasis is a distant metastasis of esophageal cancer. Several case reports have shown that radical esophagectomy and lymphadenectomy for posterior TPAN improve the prognosis of patients with cStage IVB esophageal cancer and solitary posterior TPAN metastasis; however, the true value of this procedure is unclear. The primary objective of this study was to evaluate the short- and long-term outcomes of lymphadenectomy for posterior TPAN after induction chemotherapy in esophageal cancer. Methods: This study enrolled 15 patients who underwent radical esophagectomy for cStage IVB esophageal cancer with solitary posterior TPAN metastasis after induction chemotherapy between January 2013 and October 2022 at our hospital. The short-term (e.g., blood loss, operative time, pR0 rate, postoperative complications, and postoperative hospital stay) and long-term (e.g., overall survival and recurrence-free survival) of radical esophagectomy and lymphadenectomy for posterior TPAN were retrospectively evaluated. Results:All patients who underwent radical esophagectomy and lymphadenectomy for posterior TPAN achieved a pR0 in this study. The median operative time and intraoperative blood loss were 385 minutes and 164 ml, respectively. Four patients (26.7%) had postoperative complications of Clavien-Dindo grade II or more. The median postoperative hospital stay was 15 days. The 5-year overall survival and recurrence-free survival rates were 55.6% (95% confidence interval: 23.1–79.0) and 55.0% (95% confidence interval: 25.3–77.2), respectively. Conclusions: We showed that lymphadenectomy for posterior TPAN improved the prognosis of some patients with advanced esophageal cancer and could serve as a viable treatment option for patients who respond well to induction chemotherapy.