Impact of the Number and Extent of Positive Lymph Nodes in 200 Patients with Thoracic Esophageal Squamous Cell Carcinoma after Three‐field Lymph Node Dissection

Shimada, Hideaki; Okazumi, Shinichi; Matsubara, Hisahiro; Nabeya, Yoshihiro; Shiratori, Tooru; Shimizu, Takanori; Shuto, Kiyohiko; Hayashi, Hideki; Ochiai, Takenori

doi:10.1007/s00268-005-0462-6

Cited by 91 publications

(88 citation statements)

References 22 publications

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“…The efficacy of three-field lymphadenectomy for improving the survival of patients with esophageal cancer has also been demonstrated by Lerut et al [24] and Altorki et al [25]. Many Japanese studies have subsequently reported a benefit of three-field lymphadenectomy [26,27,28,29]. …”

Section: Esophageal Resectionmentioning

confidence: 82%

Surgical Treatment for Esophageal Cancer

Kato

Fukuchi²,

Miyazaki³

et al. 2007

Dig Surg

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Esophageal cancer is one of the most difficult malignancies to cure. The prognosis remains unsatisfactory despite significant advances in surgical techniques and perioperative management. The optimal treatment strategy for localized esophageal cancer has not yet been established. Surgical resection remains the mainstay of treatment for esophageal cancer, and curative resection is the most important surgery. Extended esophagectomy with three-field lymphadenectomy provides the highest quality of tumor clearance and prolongation of patient survival. There has been intense effort in developing novel strategies to treat patients with resectable esophageal cancer. Various combined-modality approaches have been attempted to improve treatment outcomes. Definitive chemoradiotherapy has an impact on long-term survival in patients with resectable esophageal cancer. Accordingly, there are three main combined-modality approaches: esophagectomy with adjuvant chemotherapy or chemoradiotherapy; primary definitive chemoradiotherapy with or without salvage esophagectomy, and preoperative chemoradiotherapy followed by planned esophagectomy. Recently, owing to the remarkable advances in optical technology, minimally invasive esophagectomy using endoscopic instruments has been introduced into esophageal cancer surgery. This article reviews recent changes in the treatment of esophageal cancer surgery, and considers the role of esophagectomy.

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Section: Esophageal Resectionmentioning

confidence: 82%

Surgical Treatment for Esophageal Cancer

Kato

Fukuchi²,

Miyazaki³

et al. 2007

Dig Surg

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“…Lymph nodes metastases to the neck, chest, and abdomen have been detected frequently in resected specimens from patients with thoracic esophageal squamous cell carcinoma (ESCC) (1). Thus, subtotal esophagectomy plus three-field lymph node dissection (cervical, thoracic and abdominal) has been introduced as an effective therapeutic strategy for the treatment of localized thoracic ESCC in Japan (2,3). However, due to high morbidity and mortality rates following thoracotomy and laparotomy for patients with thoracic ESCCs, the use of surgery to treat this condition has been limited (4,5).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of prognostic markers for patients with curatively resected thoracic esophageal squamous cell carcinomas

Ikeguchi

Kouno

Kihara

et al. 2016

Molecular and Clinical Oncology

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Abstract. The Glasgow Prognostic Score (GPS), neutrophil/lymphocyte ratio (NLR) and prognostic nutritional index (PNI) are prognostic parameters for malignancies. Additionally, serum squamous cell carcinoma antigen (SCC-Ag) and cytokeratin 19 fragments (CYFRA 21-1) are tumor markers for squamous cell carcinoma. In the present study, the prognostic importance of these markers in patients with resectable thoracic esophageal cancer was investigated. In this retrospective study, 84 enrolled patients diagnosed with resectable clinical stage I-III thoracic esophageal squamous cell carcinomas (ESCCs) underwent thoracic esophageal resection and three-field lymph node dissection at Tottori University Hospital between January 2007 and December 2013. The correlations among preoperative patient markers (GPS, NLR, PNI, SCC-Ag and CYFRA 21-1) and the occurrence of postoperative complications and patient survival were analyzed. The operative mortality was 2.4%, and morbidity was 42.9%. Strong correlations between occurrence of postoperative complications and open thoracotomy (P=0.083) and high-serum CYFRA 21-1 (P=0.007) were observed. In 15 patients with high-serum CYFRA 21-1, postoperative complications were detected in 11 of them (73.3%); on the other hand, complications occurred in 25 of 69 (36.2%) with low-serum CYFRA 21-1. The 5-year disease-free survival rate and 5-year overall survival rate of all the patients were 52.2 and 50.8%, respectively. Among the prognostic parameters, preoperative high NLR was determined to be a poor prognostic factor, independent of the tumor stage in the multivariate analysis. These results may indicate that, in patients with preoperative high-serum CYFRA 21-1, more attention should be paid to the occurrence of postoperative complications. Therefore, in such cases, anastomosis between blood vessels of the substitute esophagus and cervical vessels would be recommended. Furthermore, in patients with high preoperative NLR, effective adjuvant chemoradiotherapy should be considered to prolong the patients' survival, even of stage I or II patients.

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“…1) Despite advances in surgical treatment, surgery alone has not improved the prognosis of patients with T4 esophageal tumors. [2][3][4] Furthermore, the combination of resection of neighboring organs with esophagectomy has not improved survival despite the high incidence of morbidity and mortality. 4,5) On the other hand, palliative resection (R1 or R2) followed by radiotherapy with or without chemotherapy has also failed to improve survival compared with nonsurgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Makino

Doki

2011

ATCS

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The outcome of patients with T4 esophageal cancer, defined as a tumor that invades neighboring structures (e.g., aorta, trachea, bronchus, and lung), is extremely poor. Despite recent advances in surgical techniques, these tumors are usually considered inoperable. Two distinct therapeutic options are currently available for T4 esophageal cancers: chemo-radiotherapy followed by surgery (CRT-S), which comprises esophagectomy following down-staging of the tumor by CRT, and definitive chemo-radiotherapy (D-CRT), which is designed to avoid esophagectomy by using maximum doses of irradiation. CRT-S is superior to D-CRT with respect to local control and short-term survival although CRT-S is associated with relatively higher perioperative mortality and morbidity. On the other hand, it is sometimes difficult to achieve local control with D-CRT and the treatment often results in fistula formation, though a complete response to CRT is often associated with better prognosis. Admittedly, the difference in the survival rate between the two modalities is marginal at long-term follow-up due to operative morbidity and inadequate control of distant metastasis in CRT-S. Changes in perioperative management and intensive systemic chemotherapy may enhance the outcome. Randomized controlled trials involving large population samples are needed to define the standard treatment for T4 esophageal cancer.

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Impact of the Number and Extent of Positive Lymph Nodes in 200 Patients with Thoracic Esophageal Squamous Cell Carcinoma after Three‐field Lymph Node Dissection

Abstract: Together, number and extent of positive lymph nodes can be considered an independent predictor of a high risk of recurrence. Although cervical lymphatic spreading was risk factor for worse survival, patients with upper tumors may have survival benefit after cervical lymph node dissection.

Cited by 91 publications

References 22 publications

Surgical Treatment for Esophageal Cancer

Surgical Treatment for Esophageal Cancer

Evaluation of prognostic markers for patients with curatively resected thoracic esophageal squamous cell carcinomas

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

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