Effects of standard and total two-field lymph node dissection on prognosis of patients undergoing Esophagectomy

Objectives: To investigate the effects of standard two-field lymph node dissection (2FLND) and total 2FLND on the short-term and long-term clinical efficacy and complications of patients undergoing esophagectomy. Methods: The clinical data of 268 patients undergoing radical Ivor-Lewis esophagectomy in our hospital from January 2008 to November 2015 were analyzed retrospectively. According to different methods of lymph node dissection (LND), the patients were divided into standard 2FLND group (n = 121) and total 2FLND group (n = 147). The LND status, postoperative complications, survival rate and lymph node recurrence of the two groups were analyzed. Results: Lymph node metastasis rate showed no statistically significant difference between the standard 2FLND group and the total 2FLND group (71.1% and 63.3%, respectively, P > 0.05). The incidence of postoperative complications was 5.8% (7/121) in the standard 2FLND group, which was lower than that in the total 2FLND group [17.0% (25/147)], with a statistically significant difference (χ2 = 7.948, P < 0.01). The 5-year survival rate of the standard 2FLND group and the total 2FLND group was 29.8% and 28.6%, respectively, without statistically significant difference (χ2 = 0.005, P > 0.05). The lymph node recurrence rate in the standard 2FLND group was 41.3% (50/121), which was higher than 19.0% (28/147) of the total 2FLND group (χ2 = 15.959, P < 0.01). Conclusion: Compared with standard 2FLND, total 2FLND does not improve the postoperative survival of patients with esophageal carcinoma, and the risk of complications is higher.

[1]  Yu-Shang Yang,et al.  Pattern of subcarinal lymph node metastasis and dissection strategy for thoracic esophageal cancer , 2020, Journal of thoracic disease.

[2]  Jie He,et al.  Lymph node dissection and recurrent laryngeal nerve protection in minimally invasive esophagectomy , 2020, Annals of the New York Academy of Sciences.

[3]  M. Achiam,et al.  Isolated tumor cells in the regional lymph nodes in patients with squamous cell carcinoma of the esophagus are rarely observed but often represent part of a true metastasis. , 2020, Annals of diagnostic pathology.

[4]  H. Grabsch,et al.  Trends in treatment and overall survival among patients with proximal esophageal cancer , 2019, World journal of gastroenterology.

[5]  K. Yamashita,et al.  Lymph Node Progression and Optimized Node Dissection of Middle Thoracic Esophageal Squamous Cell Carcinoma in the Latest Therapeutic Surgical Strategy , 2019, Annals of Surgical Oncology.

[6]  Y. Mao,et al.  [Thoracic recurrent laryngeal nerve lymph node metastasis guides the cervical lymph node dissection of patients with esophageal cancer]. , 2019, Zhonghua zhong liu za zhi [Chinese journal of oncology].

[7]  J. Ruurda,et al.  Surgical treatment of esophageal cancer in the era of multimodality management , 2018, Annals of the New York Academy of Sciences.

[8]  Fan Wang,et al.  Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer , 2018, Cancer management and research.

[9]  Wei Wang,et al.  Enhanced recovery after surgery (ERAS) programs for esophagectomy protocol for a systematic review and meta-analysis , 2018, Medicine.

[10]  Q. Xue,et al.  [Pattern of lymphatic metastasis and risk factor of esophageal carcinoma that invades less than adventitia]. , 2015, Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery.

[11]  Chia-Chuan Liu,et al.  Radical Lymph Node Dissection in Primary Esophagectomy for Esophageal Squamous Cell Carcinoma. , 2015, The Annals of thoracic surgery.

[12]  Yu Bai,et al.  [Analysis of prognostic factors in patients with recurrent and metastatic esophageal carcinoma]. , 2015, Zhonghua zhong liu za zhi [Chinese journal of oncology].

[13]  Yu-Chung Wu,et al.  Role of right upper mediastinal lymph node metastasis in patients with esophageal squamous cell carcinoma after tri-incisional esophagectomies. , 2014, Surgery.

[14]  H. Matsubara,et al.  Lymph node dissection for esophageal cancer , 2013, General Thoracic and Cardiovascular Surgery.

[15]  Chang-rong Wu,et al.  [Analysis of the therapeutic effect of esophagectomy with extended 2-field lymph node dissection for esophageal carcinoma]. , 2009, Zhonghua zhong liu za zhi [Chinese journal of oncology].

[16]  Chang-rong Wu,et al.  [Regulations and lymphadenectomy strategy of mediastinal and upper abdominal lymph node metastasis in thoracic esophageal carcinoma]. , 2007, Ai zheng = Aizheng = Chinese journal of cancer.

[17]  Hua Zhang,et al.  [Lymphatic metastasis intensity of and lymphadenectomy for thoracic esophageal squamous cell carcinoma]. , 2006, Ai zheng = Aizheng = Chinese journal of cancer.