Impact of two‑field or three‑field lymphadenectomy on overall survival in middle and lower thoracic esophageal squamous cell carcinoma: A single‑center retrospective analysis

Abstract

Squamous cell carcinoma is the main subtype of esophageal cancer in East Asia. The effect of the number of lymph nodes (LNs) removed to treat middle and lower thoracic esophageal squamous cell carcinoma (ESCC) in China remains controversial. Therefore, the present study aimed to investigate the impact of the number of LNs removed during lymphadenectomy on the survival of patients with middle and lower thoracic ESCC. Data were obtained from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database from January 2010 to April 2020. Either three-field systematic lymphadenectomy (3F group) or two-field systematic lymphadenectomy (2F group) was performed for ESCC cases with or without suspicious tumor-positive cervical LNs, respectively. Subgroups were designed for further analysis based on the quartile number of resected LNs. After 50.7 months of median follow-up, 1,659 patients who underwent esophagectomy were enrolled. The median overall survival (OS) of the 2F and 3F groups was 50.0 months and 58.5 months, respectively. The OS rates at 1, 3 and 5 years were 86, 57 and 47%, respectively, in the 2F group, and 83, 52 and 47%, respectively, in the 3F group (P=0.732). The average OS of the 3F B and D groups was 57.7 months and 30.2 months, respectively (P=0.006). In the 2F group, the OS between subgroups was not significantly different. In conclusion, resection of >15 LNs during two-field dissection in patients with ESCC undergoing esophagectomy did not affect their survival outcomes. In three-field lymphadenectomy, the extent of LNs removed could lead to different survival outcomes.

Effect of cervical paraesophageal lymph node metastasis versus supraclavicular lymph node metastasis on the overall survival of patients with thoracic esophageal squamous cell carcinoma: an observational study

“…Tachimori et al . proposed that the zones of LN metastasis and tumor locations had different efficacy indexes (EI) in their outcomes; this was further verified in the Chinese data 19 , 23 , 24 . Their study has revealed that the 5-year OS rate for patients with LNM in the supraclavicular region was 27.7–60.7%.…”

“…Lymph node metastasis (LNM) is a critical factor in determining the prognosis of individuals with thoracic ESCC, reflecting the degree of disease spread and the potential for systemic dissemination 16 – 18 . Lymphadenectomy is crucial in the surgical procedure of esophagectomy 19 . In 1990, Isono et al .…”

“… 18 proposed the concept of dissection of cervical lymph nodes (LNs) during esophagectomy. According to the guidelines established by the Japan Esophageal Society (JES), cervical paraesophageal (station 101) LNM and supraclavicular (station 104) LNM are indicative of locally advanced disease 7 , 19 . However, only supraclavicular LNM is classified as distant metastasis and categorized as M1 based on the Union for International Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) 20 .…”

Impact of Metastatic Lymph Nodes on Survival of Patients with pN1-Category Esophageal Squamous Cell Carcinoma: A Long-Term Survival Analysis

“… 24 However, the extent of lymphadenectomy in esophagectomy still is a topic of continued discussion. 18 – 20 , 25 , 26 Considering the pattern of metastasis in ESCC, LN stations have certain clinical value and are gaining increased importance. 8 , 27…”

“… 6 , 7 , 9 , 16 Lymph node (LN) metastasis (LNM) poses a significant challenge to the curative effect of the standard treatment options. 17 – 20 …”