Past, present, and future of three‐field lymphadenectomy for thoracic esophageal cancer

Abstract

In spite of repeated appeal of the effectiveness of three‐field lymphadenectomy (3FL) by Japanese esophageal surgeons, it has not been accepted worldwide as a standard therapeutic measure for thoracic esophageal cancer. In this review, a concise summary of the history of 3FL, its present position, and its future perspective is discussed. Although a lack of randomized controlled trial (RCT) is one of the largest criticisms of 3FL, it seems difficult to make 3FL world‐standard even if a RCT with a positive result was made. The essence of 3FL has revealed the fact that bilateral cervical paraesophageal nodes and nodes in the bilateral supraclavicular fossae are regional nodes of thoracic esophageal cancer. To let the world admit this essence should be the real endpoint of “3FL issue” without RCT. In the era of new modalities, Japanese surgeons should be free from the idea that 3FL is indispensable though the essence of 3FL should remain.

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

“…However, the range of LN dissection in resectable middle and lower thoracic ESCC remains controversial. Three-field lymphadenectomy has been widely accepted as a standard procedure for ESCC patients in Japan but is not yet the world standard [ 17 , 18 ]. Cervical LN metastases are common in ESCC patients, with a metastatic rate of at least 20 percent [ 19 ].…”

Clinical Impact of Remnant Lymphatic Invasion on The Recurrence of Esophageal Squamous Cell Carcinoma After Esophagectomy with Neoadjuvant Chemotherapy: A Retrospective Study

“…The widespread use of 3-FL in Japan is due to the rapid increase in the number of laparoscopic esophagectomy for esophageal cancer in recent years [30]. Meta-analyses and studies comparing 3-FL and 2-FL reported a tendency for a better prognosis of the 3-FL group [31][32][33][34][35][36][37]. Ye et al [34] reported that 3-FL provides a better 5-year survival rate than 2-FL for thoracic esophageal cancer with lymph node metastasis.…”

The Role of Adjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma Patients with Pathological Positive Lymph Nodes After Neoadjuvant Chemotherapy Followed by Esophagectomy: a Single Institute Retrospective Analysis

“…However, in Japan where adenocarcinomas of the lower esophagus and esophagogastric junction are more prevalent than in Western countries, squamous cell carcinoma of the thoracic esophagus is the most common type of esophageal cancer. Traditionally, subtotal esophagectomy and three-field lymphadenectomy, including cervical lymphadenectomy, have been standard in Japan [ 18 ]. Additionally, to prevent recurrence after surgery, NAC rather than postoperative chemotherapy is administered in Japan, based on clinical trial results.…”