Does recurrent laryngeal nerve lymph node metastasis really affect the prognosis in node-positive patients with squamous cell carcinoma of the middle thoracic esophagus?

Abstract

BackgroundRecurrent laryngeal nerve (RLN) lymph node metastasis used to be shown a predictor for poor prognosis in esophageal squamous cell carcinoma. The purpose of this study was to evaluate the prognostic impact of RLN node metastasis and the number of metastatic lymph nodes in node-positive patients with squamous cell carcinoma of middle thoracic esophagus.MethodsA cohort of 235 patients who underwent curative surgery for squamous cell carcinoma of middle thoracic esophagus was investigated. The prognostic impact was evaluated by univariate and multivariate analyses.ResultsLymph node metastasis was found in 133 patients. Among them, 81 had metastatic RLN nodes, and 52 had at least one positive node but no RLN nodal involvement. The most significant difference in survival was detected between patients with metastatic lymph nodes below and above a cutoff value of six (P < 0.001). Multivariate analysis revealed that the number of metastatic lymph nodes was a significant factor associated with overall survival (P < 0.001), but RLN lymph node metastasis was not (P = 0.865).ConclusionsRLN Lymph node metastasis is not, but the number of metastatic nodes is a prognostic predictor in node-positive patients with squamous cell carcinoma of the middle thoracic esophagus.

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

“…The RLN LN is one of the most common metastatic sites in oesophageal cancer, and previous research has reported that the RLN LN metastasis rate is 15-42% (19,(21)(22)(23). Ye et al (17) reported that the rates of left and right RLN LN metastasis were 15.8% and 20.8%, respectively, and Kanemura et al (19) reported rates of 15.4% and 16.9%, respectively.…”

Two-Stage Indicators to Assess Learning Curves for Minimally Invasive Ivor Lewis Esophagectomy

“…To select suitable indicators for MIE learning curve assessment, all possibly relevant parameters including total surgical time, intrathoracic anastomosis time, thoracic surgical time, abdominal surgical time, intraoperative blood loss, total lymphadenectomy number, bilateral RLN lymphadenectomy number, thoracic lymphadenectomy number, and abdominal lymphadenectomy number were recorded and analyzed via regression analysis. Given that the intrathoracic anastomosis manipulation had a great impact on postoperative morbidity and mortality, and that bilateral RLN lymphadenectomy was closely related to postoperative survival, 13,14 the intrathoracic anastomosis time and bilateral RLN lymphadenectomy number were selected as indicators to assess the learning curve; their respective inflection points, as determined by statistical calculation of regression analysis, were used to stratify the patients. The intrathoracic anastomosis time was defined as the duration between pulling the gastric conduit through hiatus and buttressing the anastomosis with an omental flap.…”

Robotic-assisted minimally invasive oesophagectomy for cancer: An initial experience

“…Where the overall incidence of RLN palsy, especially after McKeown's oesophagectomy varies from 0% to 58%,[19] reports suggest clearing lymph nodes from RLNs is necessary for better survival for SCC of midoesophagus. [20] However, with the introduction of minimally invasive techniques, this frequency is drastically reduced. Shen et al .…”