Three-field lymph node dissection in treating the esophageal cancer

Abstract

There are many controversies in lymphadenectomy for thoracic esophageal cancer, and whether 3-field lymphadenectomy or 2-field lymphadenectomy is better have still been in doubt. The aim of this article is to review the role of the lymph node dissection by introducing the merits and demerits in 3-field lymphadenectomy, and the development in lymphadenectomy's selection, treatment and diagnosis. All the literatures related to esophageal lymphadenectomy and minimally invasive surgery (MIE) were searched in PubMed database and the cross references were added and reviewed to complete the reference list.Several researches elucidated that better overall survival (OS) in patients with esophageal cancer after 3-field lymphadenectomy had been reported worldwide, and 3-field lymphadenectomy is more suitable for treating esophageal cancer with cervical and/or upper mediastinal lymph nodes metastasis than 2-field lymphadenectomy regardless of the tumor's histology and location. Many approaches based on the characteristics of esophageal cancer lymph node metastasis are taken to improve the accuracy of 3-field lymphadenectomy and decrease the postoperative morbidity and mortality, while every approach needs further studies to demonstrate its feasibility. The benefits of the recently rapid-developed techniques performed in treating esophageal cancer: the MIE and the robotic-assisted thoracoscopic esophagectomy are illuminated as well, and both of them are technically safe and feasible for esophageal cancer, whereas further evaluations are still necessary.

Development and validation of nomograms to intraoperatively predict metastatic patterns in regional lymph nodes in patients diagnosed with esophageal cancer

“…However, in clinical practice, although extended systematic nodal dissection is regarded as the best treatment for patients, the possibility of omitting positive lymph nodes also exists and a high occurrence of postoperative complications makes it difficult for surgeons to choose the best strategy of lymph node dissection [ 21 , 22 ]. Surgeons face a dilemma about how to perform lymph node dissection and they must make this decision based on their experience [ 23 , 24 ].…”

Three-field lymph node dissection in esophageal cancer surgery

“…Recently, several systematic reviews and meta-analyses have been reported (42)(43)(44). Shang et al analyzed the longterm survival and showed that 3FD was superior to 2FD for patients with LN metastasis in the cervical or upper mediastinal LNs (44). Ma et al reported a meta-analysis and demonstrated that 3FD could lead to improved survival rates following an esophagectomy (43).…”

Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer

“…Esophagectomy with two-field lymphadenectomy or three-field lymphadenectomy (3FL) is the typical strategy for resectable EC. However, the extent of lymph node dissection is still controversial 11. Radiotherapy or chemoradiotherapy is a prior choice for unresectable EC.…”

“…Involved-field irradiation and elective nodal irradiation are both available. No matter which method is used, it is a fact that EC has a poor survival and the lymph node recurrence is a main failure 11–14. Though much experience in patterns of LNM for EC has been accumulated in past decades, it is challenging to evaluate the status of LNM and to make a reasonable treatment plan for different patients.…”