Development of a prediction model for the risk of recurrent laryngeal nerve lymph node metastasis in thoracolaparoscopic esophagectomy with cervical anastomosis

Abstract

Background: There are no effective preoperative diagnostic measures to predict the probability of left and right recurrent laryngeal nerve (RLN) lymph node (LN) metastasis using preoperative clinical data in patients undergoing thoracolaparoscopic esophagectomy with cervical anastomosis. Methods:We retrospectively reviewed the clinical data of 1,660 consecutive patients with thoracic esophageal cancer who underwent esophagectomy with cervical anastomosis at the Department of Thoracic Surgery at the First Affiliated Hospital of Zhengzhou University between January 2015 and December 2020.Results: A total of 299 and 343 patients who underwent left (Cohort 1) and right (Cohort 2) RLN LN dissection were included in the final analyses. The analyses were conducted within each cohort. Among the 299 patients in Cohort 1, left RLN LN involvement was found in 41 patients (13.7%). A multivariable analysis showed that age, tumor location, and short axis were significantly associated with RLN LN metastasis (all P<0.05). Among the 343 patients in Cohort 2, right RLN LN involvement was found in 65 patients (19.0%). A multivariable analysis showed that computed tomography (CT) appearance, tumor location, long axis, and short axis were significantly associated with RLN LN metastasis (all P<0.05). Based on the results of the multivariable analyses, we constructed nomograms that could estimate the probability of RLN LN metastasis. Finally, we stratified the 2 cohorts into risk subgroups using a recursive partitioning analysis (RPA). The risk of left and right RLN LN metastasis was found to be 9.3% and 7.5%, 27.3% and 21.4%, and 52.4% and 47.3% for the low-risk, intermediate-risk, and high-risk groups, respectively.Conclusions: Our nomograms and RPAs appear to be suitable for the risk stratification of left and right RLN LN metastasis in patients undergoing thoracolaparoscopic esophagectomy with cervical anastomosis. This tool could be used to help clinicians to select more effective locoregional treatments, such as surgical protocols and radiation area selection.

Preoperative Clinical Characteristics Predict Recurrent Laryngeal Nerve Lymph Node Metastasis and Overall Survival in Esophageal Squamous Cell Carcinoma: A Retrospective Study With External Validation

“…The recurrent laryngeal nerve (RLN) lymph nodes (LNs) are the crucial indicator during esophagectomy, which may decide the necessity of cervical lymphadenectomy in some previous studies ( 4 , 5 ). The RLN LNM in patients with ESCC is frequently observed at a rate of 18–63% in the previous studies ( 6 – 13 ). Routine esophagectomy with three-field lymph node resection for all ESCC patients is still controversial due to the balance of complication and survival ( 9 , 14 ).…”

“…In CT images, a diameter of RLN LNM could reflect the status of RLN LNM and short diameter RLN LNs greater than 10 mm are usually judged as metastasis. However, previous studies demonstrated that the cut-off of the short diameter of RLN LNs to diagnose metastasis was shorter than 10 mm, like 6.5 mm ( 19 ) and 7.5 mm ( 6 ). Additionally, it is well-known that using a CT image to distinguish benign inflammation of LNs from malignant metastasis and to diagnose metastasis in LNs less than 5 mm is difficult.…”

“…Recently, Zhang et al. ( 6 ) reported a preoperative nomogram to predict left and right RLN LNM, but their nomogram did not include several critical clinical characteristics like clinical T stage and tumor differentiation. Moreover, all previous studies lacked internal or external validation, which may result in inaccurate performance assessment.…”

“…Previous studies reported the risk factors for RLN LNM in esophageal cancer, but the predictive value is limited for a single risk factor ( 4 , 17 , 18 ). Although several reports of a prediction model is based on clinicopathological characteristics for RLN LNM, the performance of a preoperative prediction model needs further evaluation ( 6 , 19 , 20 ). This retrospective study was conducted to assess the preoperative clinical characteristics of ESCC patients and to develop and validate a preoperative nomogram for predicting RLN LNM.…”

Development and validation of a nomogram for prediction of cervical lymph node metastasis in middle and lower thoracic esophageal squamous cell carcinoma

“…Previous studies reported that the sensitivity of CT evaluation was 30–64.7% [ 39 , 40 ]. MRI has a better performance in discriminating benign or malignant LNs, but it is a relatively expensive and time-consuming procedure [ 41 ]. PET/CT could provide additional metabolic and functional information, but it still remained controversial in evaluating cervical LN status in ESCC [ 42 ].…”