Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition)

Li, Hui; Fang, Wentao; Yu, Zhentao; Mao, Yousheng; Chen, Long-Qi; He, Jie; Rong, Tiehua; Chen, Chun; Chen, Haiquan; Chen, Ke-Neng; Du, Min; Han, Yongtao; Hu, Jian; Fu, Jianhua; Hou, Xiaobin; Gong, Taiqian; Yin, Li; Liu, Junfeng; Liu, Shuoyan; Tan, Lijie; Tian, Hui; Wang, Qun; Xiang, Jiaqing; Xu, Meiqing; Ye, Xin; You, Bin; Zhang, Renquan; Zhao, Yan

doi:10.21037/jtd.2018.03.175

Cited by 41 publications

(46 citation statements)

References 58 publications

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“…The two major distinct histological types of EC are squamous cell carcinoma (SCC) and adenocarcinoma (AC). There are marked differences between their pathological patterns in terms of incidence, natural history, and therapeutic scheme (1)(2)(3). More than one-half of the new cases in the United States and Western Europe were diagnosed as AC, while the predominate type in East Asian countries, such as China, was SCC (1,2).…”

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confidence: 99%

“…More than one-half of the new cases in the United States and Western Europe were diagnosed as AC, while the predominate type in East Asian countries, such as China, was SCC (1,2). EC generally presents as locally advanced disease and requires multidisciplinary treatment (3,4). Prominent progress has been made in early detection techniques, surgical procedures, and perioperative adjuvant therapies (4,5).…”

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confidence: 99%

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Multiple primary malignancies for squamous cell carcinoma and adenocarcinoma of the esophagus

Chen¹,

Fan²,

Mo³

et al. 2019

J. Thorac. Dis.

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Background: Patients with esophageal cancer (EC) frequently have multiple primary cancers. We conducted the present study to assess the risk of multiple primary malignancies for patients with squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the esophagus and to investigate the influence of multiple primary tumors on the prognosis of EC patients. Methods: Using the data of 44,091 EC patients from the Surveillance Epidemiology and End Results (SEER) database, we calculated the standardized incidence ratios (SIRs) for overall multiple primary cancers and cancers at particular sites among EC survivors. The SIRs of esophageal SCC and AC patients were compared using Poisson regression. The Kaplan-Meier (KM) method was used for survival analysis. Results: Multiple primary cancer risk was significantly increased among both esophageal SCC and AC survivors (SIR: 2.28 and 1.57, respectively; P<0.001). Among SCC patients, the highest SIRs were found in the oral cavity and pharynx (SIR: 16.54), esophagus (SIR: 10.02), and larynx (SIR: 10.34). Also, the highest SIRs following AC cases were observed in the esophagus (SIR: 8.81), stomach (SIR: 9.29), and small intestine (SIR: 4.95). SIRs for the oral cavity and pharynx, lung, and larynx were significantly higher among SCC survivors than AC survivors (all P<0.05). KM analysis revealed no significant difference of overall survival (OS) for multiple primary cancers, including those of the esophagus, stomach, oral cavity and pharynx, and lung among EC patients (log rank =2.04; P=0.564), except for prostate cancer (log rank =96.65; P<0.001). Conclusions: Multiple primary malignancy risk differed by the histological type of esophageal SSC and AC survivor. However, no significant relationship between survival and the multiple primary cancer sites, except for prostate cancer, was observed.

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confidence: 99%

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confidence: 99%

Multiple primary malignancies for squamous cell carcinoma and adenocarcinoma of the esophagus

Chen¹,

Fan²,

Mo³

et al. 2019

J. Thorac. Dis.

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“…There is reason to suspect the traditional open surgery is bene cial to perform the systematic lymphadenectomy under direct vision, while the operation eld observed by the monitor in MIE was lacking in partial depth perception due to its two dimensions. Although the number of lymph node harvested was fewer in MIE than open surgery in our study, the lymph node yield was in excess of the recommended threshold of 11-15 nodes required for accurate staging [21]. It is well established that dissected lymph node comprehensively provides useful prognostic information after surgery.…”

Section: Discussionmentioning

confidence: 54%

Minimal invasive versus open esophagectomy for patients with esophageal squamous cell carcinoma after neoadjuvant treatments

Chen

Wang

et al. 2020

Preprint

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Background Although previous studies have discussed whether the minimally invasive esophagectomy (MIE) is superior to open surgery, the data concerning esophageal squamous cell carcinoma (ESCC) patients underwent neoadjuvant treatment followed by radical resection is limited. The purpose of our study was to compare the short- and long-term clinical outcomes of the two surgical approaches in treating ESCC patients.MethodsBetween January 2010 and December 2016, ESCC patients who had received neoadjuvant therapy and underwent Mckeown esophagectomy at our institute were eligible. The baseline characteristics, pathological data, short-and long-term outcomes of these patients were collected and compared based on the surgical approach. ResultsA total of 195 patients was included in the current study. Compared to patients underwent open surgery, patients underwent MIE had shorter operative time and less intraoperative bleeding (390 min vs 330 min, P=0.001; 204 ml vs 167 ml, P=0.021). In addition, the risk of anastomotic leakage was decreased in MIE group (20.0% vs 3.3%, P<0.001), while the occurrence of other complications did not have statistical significance between two groups. Overall survival (OS) and disease-free survival (DFS) was no difference in patients received neoadjuvant chemotherapy between the two approaches. For the patients underwent neoadjuvant chemoradiotherapy, OS was significantly better in the MIE group (log rank=6.197; P=0.013). ConclusionMinimally invasive Mckeown esophagectomy is safe and feasible for ESCC patients who underwent neoadjuvant therapy. MIE approach presented better perioperative results than open esophagectomy. The effect of surgical approaches on survival was depending on the scheme of neoadjuvant treatment.

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“…According to the NCCN guidelines for the treatment of esophageal and esophagogastric junction cancers, at least 15 nodes should be removed in radical resection for esophageal cancer. 22 Complete resection of the esophagus and regional LNs is essential to improve long-term survival. 23 To avoid inaccurate LN dissection, which may result in inappropriate pathologic nodal staging and treatment, a phenomenon called stage migration, 24 our study only included patients who had more than 15 LNs removed.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes Between McKeown and Sweet Esophagectomy in the Elderly Patients for Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

Chen

et al. 2020

Cancer Control

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The aim of this study was to compare the perioperative outcomes and long-term survival rates of the McKeown and Sweet procedures in patients with esophageal cancer younger than 70 years or older than 70 years. A total of 1432 consecutive patients with esophageal squamous cell carcinoma (ESCC) who received surgery at Sun Yat-sen University Cancer Center from January 2009 to October 2012 were analyzed. Propensity score matching was used to balance the clinical characteristics of the patients who underwent different surgical approaches, and 275 and 71 paired cases were matched among those younger and older than 70 years, respectively. The prognosis and postoperative outcomes were compared between the McKeown and the Sweet esophagectomy. For patients younger than 70 years, those who underwent the McKeown procedure had better overall survival (OS) than those in the Sweet group (log rank = 4.467; P = .035). However, no significant difference in disease-free survival and OS was observed between two approaches for the elderly patients (log rank = 1.562; P = .211 and log rank = 0.668; P = .414, respectively). Cox regression analysis revealed that McKeown approach was a positive prognostic factor compared to the Sweet approach for patients younger than 70 years in univariable analysis (HR = 0.790; 95% CI, 0.625-0.997; P = .047), whereas the surgical approach was not significantly related to the prognosis in the elderly patients. For patients older than 70 years, the occurrence of anastomotic fistula increased in those who underwent the McKeown procedure (23.9% vs 11.3%, P = .038, for the McKeown and Sweet esophagectomy, respectively). The McKeown approach increases the OS in younger patients with ESCC. However, for patients older than 70 years, the Sweet approach was proven to be an effective therapy, given the better perioperative outcomes and similar long-term survival compared with patients in the McKeown group.

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Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition)

Cited by 41 publications

References 58 publications

Multiple primary malignancies for squamous cell carcinoma and adenocarcinoma of the esophagus

Multiple primary malignancies for squamous cell carcinoma and adenocarcinoma of the esophagus

Minimal invasive versus open esophagectomy for patients with esophageal squamous cell carcinoma after neoadjuvant treatments

Comparison of Outcomes Between McKeown and Sweet Esophagectomy in the Elderly Patients for Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

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