Background:The benefit and harm of three-field lymphadenectomy for oesophageal cancer are still unknown. The aim of this study was to compare overall survival and morbidity and mortality between three-and two-field lymphadenectomy in patients with oesophageal squamous cell carcinoma.
Methods: Between March 2013 and November 2016, patients with squamous cell carcinoma of the middle or distal oesophagus were assigned randomly to open oesophagectomy with three-field (cervical-thoracic-abdominal) or two-field (thoracic-abdominal) lymphadenectomy. No chemo(radio) therapy was given before surgery. This paper reports on the secondary outcomes of the study: pathology and surgical complications. Results: Some 400 patients were randomized, 200 in each group. A median of 37 (i.q.r. 30-49) lymph nodes were dissected in the three-field group, compared with 24 (18-30) in the two-field group (P < 0⋅001). Some 43 of 200 patients (21⋅5 per cent) in the three-field group had cervical lymph node metastasis. More patients in the three-field group had pN3 disease: 21 of 200 (10⋅5 per cent) versus 10 of 200 (5⋅0 per cent) (P = 0⋅040). The rate and severity of postoperative complications were comparable between the two groups, except that six patients in the three-field arm needed reintubation compared with none in the two-field group (3⋅0 versus 0 per cent; P = 0⋅030). The 90-day mortality rate was 0 per cent in the three-field group and 0⋅5 per cent (1 patient) in the two-field group (P = 1⋅000).Conclusion: Oesophagectomy with three-field lymphadenectomy increased the number of lymph nodes dissected and led to stage migration owing to a 21⋅5 per cent rate of cervical lymph node metastasis. Postoperative complications were largely comparable between two-and three-field lymphadenectomy. Registration number: NCT01807936 (https://www.clinicaltrials.gov).
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