Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Abstract

Background: Recurrent laryngeal nerve (RLN) injury is one of the most frequent postoperative complications of esophageal squamous cell carcinoma (ESCC) radical resection. This study aims to develop a novel scoring system to predict recurrent laryngeal nerve lymph node (RLNLN) metastases in early ESCC and explore the indications for precise RLN lymphadenectomy. Results: A total of 311 cases selected from 1,466 ESCC patients were divided into the dissection group and the control group. Age, tumor length, macroscopic tumor type, T stage, tumor location and tumor differentiation were independent predictors of RLNLN metastases. The weighted scoring system included age (+2 for <56 years), tumor length (+2 for over 4.45 cm), tumor location (+4 for upper thoracic, +2 for mid-thoracic) and macroscopic tumor type (+1 for advanced type). The total number of points estimated the probability of RLNLN metastases [low-risk (0-2 point), 0%; moderate-risk (3-4 points), 9.8%; and highrisk (>4 points), 43.4%]. Besides, the dissection group had more complications and similar survival rate when compared with the control group.Conclusions: We developed a novel scoring system that accurately estimated the risk of RLNLN metastases in early ESCC patients. RLN lymphadenectomy may be safely omitted for the patients in the low-risk subgroup.

A nomogram prediction model for recurrent laryngeal nerve lymph node metastasis in thoracic oesophageal squamous cell carcinoma

“…Ma et al (24) reported that RLN palsy occurred in 37.6% of patients. In the present study, the incidence of RLN injury was 13.6%, of which 53.8% (21/39) of cases led to subsequent pulmonary infection, which was a higher rate than that observed in (24,26). Imaging experts have used FDG-PET/CT or intravenous contrastenhanced CT to evaluate the risk of RLN LN metastasis; however, these modalities only showed limited predictive value (19,27,28).…”

Clinical significance and outcomes of bilateral and unilateral recurrent laryngeal nerve lymph node dissection in esophageal squamous cell carcinoma: A large‐scale retrospective cohort study

“…Thus, we excluded patients who received neoadjuvant therapy in order to more focus on examining differences in surgical techniques in operable ESCC as previous studies did. 9,12 Our findings indicate that bilateral RLNLD caused more postoperative complications, such as respiratory diseases and vocal cord paresis, while unilateral RLNLD was safer than non-RLNLD. This result is similar to that published by a previous study by Taniyama et al which reported that patients who underwent bilateral RLNLD had more frequent RLN palsy than those who did not underwent bilateral RLNLD (41% vs. 28%).…”

Clinical outcome of patients after recurrent laryngeal nerve lymph node dissection for oesophageal squamous cell carcinoma

“…The incidence of RLN LN metastasis has been reported to range from 14.2% to 39.5% [ 12 , 17–21 ]. Li et al [ 19 ] have reported the advantage of providing complete staging information after RLN LND.…”

“…More studies are needed for elucidating whether RLN LND reduces the risk of loco-regional or distant recurrences. The survival impact of RLN LND was also controversial, especially in patients who have received NCRT followed by surgery [ 12 , 13 ]. In Chao’s study that focused specifically on patients with negative ycN-RLN status, there was no significant DFS difference between patients with and without RLN LND (60.7% vs 53.8%, P = 0.439) [ 21 ].…”

“…For instance, Park et al . reported superior survival in patients who received RLN LND for pT1 OSCC, whereas Yu et al did not find any significant survival difference between patients with and without RLN LND for pT1/2 OSCC [ 12 , 13 ]. Even fewer studies have focused on the efficacy of RLN LND in patients who have received NCRT followed by surgery.…”