The importance of grouping of lymph node stations and rationale of three‐field lymphoadenectomy for thoracic esophageal cancer

Udagawa, Harushi; Ueno, Masaki; Shinohara, Hisashi; Haruta, Shusuke; Kaida, Sachiko; Nakagawa, Masatoshi; Takahashi, Masahīko

doi:10.1002/jso.23122

Cited by 163 publications

(132 citation statements)

References 8 publications

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“…The RLNLN metastases are considered as independent predictors of cervical lymph node metastases (LNM) (9)(10)(11). In addition, some scholars believe that regular RLNLN dissection is necessary for accurate staging and radical resection, particularly for middle and upper thoracic esophageal carcinomas (12). Therefore, RLNLN dissection is of great significance for ESCC radical resection.…”

Section: Original Articlementioning

confidence: 99%

Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Lin

Chen

et al. 2016

J. Thorac. Dis.

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Background: Recurrent laryngeal nerve (RLN) injury is one of the most frequent postoperative complications of esophageal squamous cell carcinoma (ESCC) radical resection. This study aims to develop a novel scoring system to predict recurrent laryngeal nerve lymph node (RLNLN) metastases in early ESCC and explore the indications for precise RLN lymphadenectomy. Results: A total of 311 cases selected from 1,466 ESCC patients were divided into the dissection group and the control group. Age, tumor length, macroscopic tumor type, T stage, tumor location and tumor differentiation were independent predictors of RLNLN metastases. The weighted scoring system included age (+2 for <56 years), tumor length (+2 for over 4.45 cm), tumor location (+4 for upper thoracic, +2 for mid-thoracic) and macroscopic tumor type (+1 for advanced type). The total number of points estimated the probability of RLNLN metastases [low-risk (0-2 point), 0%; moderate-risk (3-4 points), 9.8%; and highrisk (>4 points), 43.4%]. Besides, the dissection group had more complications and similar survival rate when compared with the control group.Conclusions: We developed a novel scoring system that accurately estimated the risk of RLNLN metastases in early ESCC patients. RLN lymphadenectomy may be safely omitted for the patients in the low-risk subgroup.

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Section: Original Articlementioning

confidence: 99%

Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Lin

Chen

et al. 2016

J. Thorac. Dis.

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“…With a pretest probability of 20%, the post-test probability of CLN, given positive and negative ultrasound results, were 80% and 3%. (43,44). In the 7 th edition of the esophageal AJCC (American Joint Committee on Cancer) staging guidelines, a regional LN has been redefined to include any paraesophageal node extending from the cervical nodes to the celiac nodes (45).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of ultrasound for the diagnosis of cervical lymph node metastasis in esophageal cancer: a systematic review and meta-analysis

et al. 2016

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Background: Esophageal cancer is considered a serious malignancy with respect to its prognosis and mortality rate. Cervical lymph node status is one of the keys to determining prognosis and treatment methods. However, published data vary regarding the accuracy of ultrasound in the diagnosis of cervical lymph node metastasis. We performed a meta-analysis to assess the efficacy of ultrasound for detecting cervical lymph node metastasis in patients with esophageal cancer. Methods:The PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were searched to identify studies related to cervical lymph node metastasis, and 22 studies comprising 3,513 patients met our inclusion criteria. We used a bivariate meta-analysis following a random effects model to summarize the data. We also explored reasons for statistical heterogeneity using meta-regression, subgroup, and sensitivity analyses. Publication bias was assessed with a Deeks funnel plot. Results:The area under the receiver operating characteristic curve was 0.97 [95% confidence interval (CI): 0.95-0.98], and the pooled diagnostic odds ratio was 121.00 ). With cut-off values of 5 mm and >5 mm for cervical lymph node size, the sensitivities and specificities (95% confidence interval) for ultrasound detection of cervical lymph node metastasis were 84% (67-93%) and 93% (90-95%); and 94% (76-98%) and 98% (89-100%), respectively. Conclusions:We show for the first time the diagnostic accuracy of ultrasound for predicting cervical lymph node-positive metastasis in esophageal cancer. Our analysis shows that ultrasonography may be an effective and reliable approach to detect cervical lymph node metastasis in esophageal cancer. However, to accommodate heterogeneity, high-quality studies are needed to further verify the efficacy of ultrasound detection. IntroductionEsophageal cancer is considered a serious malignancy with respect to its prognosis and mortality rate. An estimated 455,800 new cases of esophageal cancer and 400,200 esophageal cancer-related deaths occurred in 2012 worldwide (1). High rates of recurrence and metastasis cause high mortality among patients with esophageal cancer (2).Surgical resection has been well established as a part of multimodal treatment for esophageal cancer. The number of positive lymph nodes (LNs) removed is an independent predictor of survival in esophageal cancer after esophagectomy (3,4). Fortunately, the surgical dissection of cervical lymph nodes (CLNs) and three-field LNs contribute to a better prognosis and prolonged survival for patients with esophageal cancer (5-7). One of the most important methods to identify whether three-field lymphadenectomy should be performed is an examination of CLN status.Ultrasound (US), computed tomography (CT), and 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) are used clinically to detect regional LNs. Nevertheless, the value of CT and FDG-PET scanning is limited (8), and there is an associated financial burden and risk of high exposure to radiation. Comparatively sp...

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“…Many previous reports have shown the superiority of 3FLD as compared with twofield LN dissection (2FLD). [20][21][22][23][24][25][26][27] The discussion regarding the extent of LN dissection has mainly centered on thoracic esophageal SCC in Japan.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Current Status and Future Prospects for Esophageal Cancer Treatment

Sohda

Kuwano

2017

ATCS

164

128

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The importance of grouping of lymph node stations and rationale of three‐field lymphoadenectomy for thoracic esophageal cancer

Cited by 163 publications

References 8 publications

Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Accuracy of ultrasound for the diagnosis of cervical lymph node metastasis in esophageal cancer: a systematic review and meta-analysis

Current Status and Future Prospects for Esophageal Cancer Treatment

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