Selective three-field lymphadenectomy for thoracic esophageal squamous carcinoma

Abstract

The purpose of this study was to examine metastasis in different nodal stations and the extent of lymphadenectomy for esophageal carcinoma. Eighty-seven thoracic esophageal squamous carcinoma patients underwent esophagectomy with two-field or three-field lymphadenectomy based on cervical ultrasonography. Thirty-five patients (40.2%) with ultrasonography-detected cervical nodes underwent cervical dissection. Significantly more patients with primary tumors in the upper thoracic esophagus had cervical dissection than patients with tumors in the middle and lower esophagus (66.7%vs. 30.2%, P=0.002). Metastasis to cervical, superior mediastinal, mid-mediastinal, and abdominal nodes were 19.5%, 25.3%, 23%, and 24.1%, respectively. Cervical metastasis was 29.2%, 20.8%, and 10% for upper, middle, and lower thoracic esophageal tumors. Regional lymphadenopathy was found in 48 patients (55.2%) and was significantly related to cervical metastasis (31.3%vs. 5.1%, P=0.002). It was significantly less in upper (37.5%) than in middle (62.3%) and lower (60%) thoracic esophageal tumors (P=0.041). When cervical metastasis was included into regional lymphadenopathy, the difference was no longer significant (45.8%vs. 63.5%, P=0.135). Cervical dissection was associated with significantly more morbidities (60%vs. 34.6%, P=0.020), especially recurrent laryngeal nerve palsy (22.9%vs. 9.6%, P=0.089). Recurrent laryngeal nerve palsy was related significantly to anastomotic leakage (53.8%vs. 13.5%, P=0.001). There was no significant difference between the 2-year survivals for patients with or without cervical metastasis (50.0 vs. 72.0%, P=0.094). We conclude that cervical metastasis is of a similar rate as metastasis to mediastinal or abdominal nodes. Cervical nodes should be taken as regional lymph nodes for thoracic esophageal cancer. Cervical dissection is associated with increased morbidity and should be reserved for patients who may benefit from the procedure. Selective three-field dissection based on ultrasonography is helpful in reducing surgical morbidity while increasing the completeness of resection.

Three-field lymph node dissection in treating the esophageal cancer

“…It can be demonstrated that the upper mediastinal esophageal cancer has a higher risk of the cervical lymph node metastasis than the middle and lower mediastinal esophageal cancer in Table 5 (26)(27)(28). At the same time, Chen et al (26) reported that the cervical lymph node metastasis was independent of tumor location.…”

“…Fujita et al (28) and Kato et al (21) proposed the most frequently lymphatic recurrence after operation was found in the left upper recurrent nerve nodes and the right supraclavicular, celiac and abdominal paraaortic nodes, in contrast, the right recurrent nerve nodes metastasis was the most frequently found at operation. Meanwhile, Fang et al (54) explained that the cervical lymph node metastasis is significantly correlated with the upper and/or middle mediastinal esophageal cancer (both P<0.01), while there's no association with the lower and abdominal esophageal cancer. It seemed that the cervical lymph node dissection is more benefit for patients with the upper and middle thoracic esophageal cancer.…”

“…In some eastern countries like Japan and China, where the main type of the esophageal cancer is the squamous cell, and it usually locates in the middle and lower esophagus. So the 2-FL, which is referred to the 2F, as a standard surgical treatment has been widely used (14,16,23), and the 3-FL also has been frequently conducted in China in recent years (26,27). However, in some western countries, the adenocarcinoma of the lower esophagus or the esophagogastric junction is common.…”

High CCR7 mRNA expression of cancer cells is associated with lymph node involvement in patients with esophageal squamous cell carcinoma

“….1% deeper invasion to submucosa causes lymph node metastases, resulting in poor survival (1)(2)(3)(4)(5)(6).…”

Sentinel Node Navigation Surgery in Early-Stage Esophageal Cancer

“…A significant increase in morbidity and mortality after invasive procedures has been reported. [3][4][5] To eliminate the necessity of uniform application of highly invasive surgery, sentinel node (SN) mapping may play a significant role by obtaining individual information to permit adjustments and modifications of the surgical procedure for that specific patient.…”