Optimal Range of Lymphadenectomy in Pathological Stage T1 and T2 Esophageal Squamous Cell Carcinoma

Abstract

BackgroundLymph node metastasis is a primary contributor to tumor progression in esophageal squamous cell carcinoma (ESCC), and the optimal extent of lymphadenectomy during esophagectomy remains controversial. This study aimed to investigate the appropriate number of lymph nodes to be dissected in pT1-2Nany stage ESCC to achieve the best prognosis and avoid missing positive lymph nodes (PLNs).MethodsA total of 497 patients with pT1 to pT2 esophageal cancer from two institutions were retrospectively analyzed and their surgical and pathological records were critically reviewed. Stepwise analyses were conducted by calculating a serial of hazard ratios and odd ratios to determine the optimal range of lymphadenectomy for overall survival (OS).ResultsThe best survival outcome can be obtained when the number of lymph node examined (NLNE) is 10–18 in pT1N0 ESCC, while the NLNE should exceed 24 in pT2N0 diseases. In patients with pT1-2Nany and pT2Nany ESCC, resection of 15–25 and 24–37 lymph nodes, respectively, could provide significant added value for identifying positive nodal metastasis. When the NLNE exceeds this appropriate range, resection of extra lymph node is not helpful to improve the probability of finding PLNs.ConclusionsFor ESCC patients undergoing radical esophagectomy, the optimal extent of lymphadenectomy is 15–25 for pT1Nany disease and 24–37 for pT2Nany disease.

Comment on: The Impact of Adjuvant Therapy on Survival After Esophagectomy for Node-Negative Esophageal Adenocarcinoma

“…More extensive lymph node dissection ensures relatively accurate N staging. 2 In real-world, however, the extent of lymph node dissection depends on various factors such as preventive initiatives for reducing postoperative complications (leave certain lymph nodes which could cause severe surgical complications if dissected) and surgical skills/experience of different surgeons. Another crucial aspect of lymphadenectomy is the dissection field.…”