145. PRECISE PATTERN OF LYMPHATIC SPREAD OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA RESULTS OF 1074 PATIENTS WITH N1 DISEASE

Abstract

Abstract Objective The precise pattern of lymphatic spread in esophageal cancer remains unclear. The present study aimed to determine the pattern of lymphatic metastasis in its early stages. Methods The data were reviewed of 1074 patients who underwent curative esophagectomy for thoracic esophageal squamous cell carcinoma and metastasis in 1–2 lymph nodes between January 2015 and December 2021. The frequencies of lymph node metastasis were analyzed by the anatomic sites and regions involved. Results Of the 1074 patients, the median number of resected lymph nodes was 27 (interquartile range, 20–35). There were 668 patients (62.2%) with one positive lymph node and 406 patients (37.8%) with two positive lymph nodes. Paracardial lymph nodes were the most frequently involved nodes (35.2%), followed by the right thoracic recurrent nerve nodes (24.0%) and middle thoracic paraesophageal nodes (14.7%). The majority of lymph node metastases occurred in the longitudinal direction to the perigastric (35.2%) and bilateral recurrent nerve regions (33.0%) and in the transverse direction to the paraesophageal region (27.7%). Deep tumor depth (P = 0.047), poor tumor differentiation (P = 0.038), and lymphovascular invasion (P = 0.023) were associated with lymph node metastasis. Conclusion Perigastric nodes, bilateral recurrent nerve nodes, and paraesophageal lymph nodes were the most common early lymph node metastasis regions. Esophageal squamous cell carcinoma involves more longitudinal than transverse lymph node metastases. Two-field lymphadenectomy should include the radical lymph nodes dissection both in the upper mediastinum and in the upper abdomen.