Characteristics and clinical significance of lymph node metastases near the recurrent laryngeal nerve from thoracic esophageal carcinoma

Abstract

ABSTRACT. This study aimed to evaluate the characteristics of lymph node (LN) metastases from thoracic esophageal carcinoma near the recurrent laryngeal nerve and the influence of these metastases on patient prognosis and to determine the reasonable regional LN dissection range. The clinical data from 120 patients who underwent resection for thoracic esophageal carcinoma were analyzed retrospectively. LN metastases near the recurrent laryngeal nerve were detected in 34.2% of the cases, and the metastasis rates in the left and right LNs near the recurrent laryngeal nerve were 20.8 and 15.8%, respectively. The primary tumor site (metastasis rates for esophageal cancer in the upper thoracic segment vs chest or lower thoracic segment: 60.0 vs 40.3 or 15.8%, respectively; P < 0.01), tumor differentiation (poorly differentiated vs well differentiated or differentiated: 56.0 vs 22.0 or 35.6%, respectively; P < 0.05), and tumor invasion depth (T3 and T4 vs T1 and T2: 42.9 and 50.0% vs 8.33 and 14.3%, respectively; P < 0.01) were factors that significantly influenced LN metastasis near the recurrent laryngeal nerve LN metastases near the recurrent laryngeal nerve were associated with cervical LN metastasis. The 3-year survival rate of patients with LN metastasis near the recurrent laryngeal nerve was much lower than that of patients with other LN metastases (29.3 vs 58.2%; P < 0.05). In thoracic esophageal carcinoma cases, LNs near the recurrent laryngeal nerve should be resected. This could improve the patient prognosis and reduce the incidence of postoperative local recurrence.

Three-field lymph node dissection in treating the esophageal cancer

“…Furthermore, Yoshioka et al (44) reported the rate of cervical lymph node metastasis was 51.6% in patients with lymph node metastasis near the recurrent laryngeal nerve, while the rate was 11.6% in patients without lymph node metastasis near the recurrent laryngeal nerve (P<0.05). At the same time, Ye et al (43) reported the significant higher rate of 3-year survival in patients with lymph node metastasis near the recurrent laryngeal nerve after radical surgery with 3-FL than patients without recurrent laryngeal nerve lymph node metastasis (29.3% vs. 58.2%, respectively P<0.05). Malassagne et al (45) showed the similar outcomes with the lower rate of 5-year survival in patients with metastatic recurrent laryngeal nerve lymph node after 3-FL than that of patients with non-LN metastasis (21% vs. 47%, respectively, P<0.05).…”

“…It's believed that the dissection of the recurrent laryngeal nerve lymph node would bring a better OS after operation than those without the recurrent laryngeal nerve lymph node dissection. And the patient with positive recurrent laryngeal nerve lymph nodes who has undergone the radical esophagectomy with 3-FL will get more benefits of postoperative survival rate than patients with 2-FL (43)(44)(45). At the same time Kato et al (63) have once reported that the rate of local recurrence in 3-FL group was lower than that in Ivor-Lewis group (17% versus 38%) regardless of whether there's cervical or upper mediastinal lymph node metastasis or not.…”

“…Kato et al (21) found the right recurrent laryngeal nerve lymph nodes was the most frequent site of lymph node metastasis (16.3% in Kato's series), while Fujita et al (28) reported the most frequent lymph node recurrence after operation was seen in the lymph nodes near left recurrent laryngeal nerve. Meanwhile, in Ye et al (43) study, the rate of LN metastasis near the bilateral recurrent laryngeal nerve was 34.2%, in which 15.8% involving the left LNs and 20.8% involving the right LNs. The rate of skip metastasis to the LNs near the recurrent laryngeal nerve was 4.2%.…”

“…Malassagne et al (45) showed the similar outcomes with the lower rate of 5-year survival in patients with metastatic recurrent laryngeal nerve lymph node after 3-FL than that of patients with non-LN metastasis (21% vs. 47%, respectively, P<0.05). With too much series, it can be considered that the recurrent laryngeal nerve lymph node is a reliable and strong indicator of cervical lymph node metastasis, and it equally is an important factor affecting the postoperative survival rate of patients with esophageal cancer (43)(44)(45). Therefore the recurrent laryngeal nerve lymph node can be regarded as "sentinel node" for cervical lymph node metastasis of esophageal cancer.…”

“…The overall recurrence rate was 5%. In the meantime, several studies proposed the "sentinel node" is a good method to improve the accuracy of lymphadenectomy (43)(44)(45).…”