Prognostic impact of thoracic duct lymph node metastasis in esophageal squamous cell carcinoma

Matsuda, Satoru; Kawakubo, Hirofumi; Takeuchi, Hiroya; Irino, Tomoyuki; Fukuda, Kazumasa; Nakamura, Rieko; Wada, Norihito; Kitagawa, Yuko

doi:10.1002/ags3.12432

Cited by 7 publications

(8 citation statements)

References 32 publications

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“…Metastatic TDLNs were observed on the same or cranial level of the primary lesion in most patients with TDLN metastasis. Because this trend was consistent in our follow-up study with an expanded cohort and longer follow-up duration, 20 those results suggest that the lymphatic route along the TD, which runs from the caudal to the cranial side, seeds the cancer cells to the TDLN. The presence of TDLN was also confirmed in a cadaver study, which discovered TDLN in six of seven cadavers (86%), with a median number of 1 (range, 0–6).…”

Section: Ln Metastatic Patterns For Ecsupporting

confidence: 85%

“…In our previous study that evaluated the long-term outcomes in patients who had TDLN metastasis, the recurrence-free survival and overall survival of patients with TDLN metastasis were almost identical to those with positive LN metastasis in extraregional LNs such as supraclavicular LNs. 20 Ohkura et al investigated the EI of TDLN. Their results showed that in ECC patients with cT3–4, there was no statistically significant difference in EI between TDLNs and non-TDLNs.…”

Section: Surgical Approach To Eradicating a Wide Range Of Ln Metastas...mentioning

confidence: 99%

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Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer

Matsuda

Takeuchi

Kawakubo

et al. 2023

Diseases of the Esophagus

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Summary Abundant lymphatic flow and the anatomical location of the esophagus can result in the widespread distribution of lymph node metastasis of esophageal cancer from the cervical to the abdominal field. Historically, the Japan Esophageal Society and American Joint Committee on Cancer offer two different classifications of lymph node group location surrounding the esophagus. The location of sentinel lymph nodes in midthoracic esophageal cancer reflects the variety of lymphatic drainage routes. In fact, in cT1N0 esophageal cancer, pathological lymph node metastasis has been observed from the cervical to the abdominal field, and the locations were shown to be closely linked to the primary tumor location in advanced stages. While the impact of histology on the distribution of LN metastasis has been extensively debated, a recent prospective study on esophagogastric junction cancer found that metastatic patterns did not differ by histology. Thoracic duct lymph nodes were defined as one of the regional lymph node stations in the mediastinum. Although lymph node metastasis around the thoracic duct has occasionally been observed, the oncologic impact of thoracic duct lymph node dissection has not been fully elucidated. To eradicate tumors locoregionally, three-field lymph node dissection, a strategy for extended lymph node clearance, has been established. In esophagectomy, three-field lymph node dissection is defined as a procedure for complete regional cervico-thoraco-abdominal lymph node dissection. However, its therapeutic efficacy must be evaluated based on the balance between oncological outcomes and possible added surgical risk. To further improve survival, multidisciplinary treatment consisting of surgery, chemotherapy, and radiotherapy has been established worldwide as a standard treatment for esophageal cancer. Now that neoadjuvant therapy followed by esophagectomy is the standard, adding adjuvant therapy including immunotherapy could be a promising treatment option. The ideal combination of various multidisciplinary treatment approaches and extensive LN dissection need to be established to improve the oncological outcomes for EC patients.

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Section: Ln Metastatic Patterns For Ecsupporting

confidence: 85%

Section: Surgical Approach To Eradicating a Wide Range Of Ln Metastas...mentioning

confidence: 99%

Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer

Matsuda

Takeuchi

Kawakubo

et al. 2023

Diseases of the Esophagus

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“…Figure 1 summarizes the distribution of TDLN metastasis based on primary tumor location, demonstrating that TDLN metastasis tends to occur at the same level as the primary tumor or cranial it. This finding was confirmed in a follow-up study conducted by the same institution using a larger cohort, 12 , 13 which revealed that the lymphatic route along the TD could extend from caudal to cranial levels. In terms of prognosis, recurrence-free survival (RFS) and overall survival (OS) were significantly worse in patients with TDLN metastasis, which was shown to be an independent prognostic factor in the multivariate analysis.…”

Section: Oncological Impact Of Td Resection In Esophageal Cancer Surgerymentioning

confidence: 53%

“…Subsequently, we investigated the presence and metastatic rate of TDLN in esophageal cancer surgery. 12 , 13 As shown in Table 1 , the average number of TDLNs, including nonmetastatic nodes, was comparable across studies; this was confirmed in a cadaver study revealing the presence of TDLNs in six of seven cadavers (86%). 14 In our study, TDLN metastasis was observed in 7% of patients with surgically resectable ESCC, similar to the finding of a previous study.…”

Section: Oncological Impact Of Td Resection In Esophageal Cancer Surgerymentioning

confidence: 56%

Oncological and physiological impact of thoracic duct resection in esophageal cancer

Matsuda

Takeuchi

Kawakubo

et al. 2023

Diseases of the Esophagus

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Despite advances in multidisciplinary treatment, esophagectomy remains the main curative treatment for esophageal cancer. The advantages and disadvantages of thoracic duct (TD) resection have been controversial for decades. We have herein reviewed relevant published literature regarding ‘thoracic duct,’ ‘esophageal cancer,’ and ‘esophagectomy’ describing the anatomy and function of the TD, and incidence of thoracic duct lymph nodes (TDLN) and TDLN metastases, as well as the oncological and physiological effects of TD resection. The presence of lymph nodes around the TD, referred to as TDLN, has been reported previously. The delineation of TDLNs is clearly defined by a thin fascial structure covering the TD and the surrounding adipose tissue. Previous studies have examined the number of TDLNs and the percentage of patients with TDLN metastasis and revealed that each patient had approximately two TDLNs. The percentage of patients with TDLN metastasis was reported to be 6–15%. Several studies have been conducted to compare the survival after TD resection with that after TD preservation. However, no consensus has been reached because all studies were retrospective, precluding firm conclusions. Although the issue of whether the risk of postoperative complications is affected by TD resection is still unclear, resecting the TD has been shown to have a long-term impact on nutritional status after surgery. In summary, TDLNs are quite common and present in most patients, while metastasis in the TDLNs occurs in a minority. However, the oncological value of TD resection in esophageal cancer surgery remains controversial due to varying findings and methodological limitations of previous comparative studies. Considering the potential but unproven oncological benefits and possible physiological drawbacks of TD resection, including postoperative fluid retention and disadvantages in the long-term nutritional outcome, clinical stage, and nutritional status should be considered before deciding whether to perform TD resection or not.

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“…The effects of nCRT on the number of collected LNs could be one reason for this finding. Previous studies suggested that nCRT may sterilize micrometastases because it removes fewer LNs at dissection than surgery alone for ESCC patients [ 12 , 24 ]. Moreover, less recurrence was observed in the high e-LNS group.…”

Section: Discussionmentioning

confidence: 99%

Increased resected lymph node stations improved survival of esophageal squamous cell carcinoma

Lu,

Wei,

Liu

et al. 2024

BMC Cancer

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Background Neoadjuvant chemoradiotherapy (nCRT) and surgery have been recommended as the standard treatments for locally advanced esophageal squamous cell carcinoma (ESCC). In addition, nodal metastases decreased in frequency and changed in distribution after neoadjuvant therapy. This study aimed to examine the optimal strategy for lymph node dissection (LND) in patients with ESCC who underwent nCRT. Methods The hazard ratios (HRs) for overall survival (OS) and disease-free survival (DFS) were calculated using the Cox proportional hazard model. To determine the minimal number of LNDs (n-LNS) or least station of LNDs (e-LNS), the Chow test was used. Results In total, 333 patients were included. The estimated cut-off values for e-LNS and n-LNS were 9 and 15, respectively. A higher number of e-LNS was significantly associated with improved OS (HR: 0.90; 95% CI 0.84–0.97, P = 0.0075) and DFS (HR: 0.012; 95% CI: 0.84–0.98, P = 0.0074). The e-LNS was a significant prognostic factor in multivariate analyses. The local recurrence rate of 23.1% in high e-LNS is much lower than the results of low e-LNS (13.3%). Comparable morbidity was found in both the e-LNS and n-LND subgroups. Conclusion This cohort study revealed an association between the extent of LND and overall survival, suggesting the therapeutic value of extended lymphadenectomy during esophagectomy. Therefore, more lymph node stations being sampled leads to higher survival rates among patients who receive nCRT, and standard lymphadenectomy of at least 9 stations is strongly recommended.

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Prognostic impact of thoracic duct lymph node metastasis in esophageal squamous cell carcinoma

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 7 publications

References 32 publications

Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer

Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer

Oncological and physiological impact of thoracic duct resection in esophageal cancer

Increased resected lymph node stations improved survival of esophageal squamous cell carcinoma

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