Abstract
<strong>Background:</strong> We analyzed local regional recurrence patterns of thoracic esophageal carcinoma after three-field lymph node dissection (3-FLD) with and without postoperative radiotherapy, and assessed the postoperative radiation value for local control. <strong>Methods:</strong> The study reviewed 239 local recurrences of esophageal squamous cell carcinoma after 3-FLD from 2010 to 2018 in our hospital, retrospectively, and compared local regional recurrence patterns between surgery followed by radiotherapy (S+RT) and surgery alone (SA). <strong>Results:</strong> In 239 thoracic esophageal carcinomas that underwent curative surgery, the lymph node recurrence was the most common type of local recurrence for patients in both groups. The sequence of lymph node recurrence rate in both groups from highest to lowest was mediastinal, cervical, and abdominal. The recurrence rate of superior mediastinal lymph node in patients without radiotherapy was significantly higher than that in patients with radiotherapy (67.72% vs. 47.54%, x<sup>2</sup> = 7.615, P = 0.006). The recurrence rate of abdominal lymph node in the upper TEC was significantly lower than that in the middle and lower TEC (x<sup>2</sup> = 9.452, P = 0.009). The abdominal lymph node recurrence rate in patients with preoperative abdominal LNM was very significantly higher than that in patients without preoperative abdominal LNM (43.63% vs. 6.66%, P < 0.001). <strong>Conclusions:</strong> The dangerous lymph node recurrence regions included superior, middle mediastinum, and neck. Postoperative radiotherapy shows great value for patients in reducing superior mediastinal lymph node recurrence rate. The lower segment of thoracic esophageal carcinoma and preoperative abdominal lymph node metastasis, especially para-aortic lymph node metastasis, may be risk factors for abdominal lymph node recurrence.
Highlights
At present, the overall 5-year survival rate of esophageal carcinoma is 45.7% [1]
There is no common consensus for postoperative radiotherapy, a growing number of researchers [8,9,10,11] suggest that postoperative radiotherapy, which can reduce local recurrence, was associated with better survival rates for patients with node-positive thoracic esophageal carcinoma (TEC)
There was no significant difference between surgery followed by radiotherapy (S+RT) and surgery alone (SA) regarding lymph node recurrence (95.31% vs. 90.29%, P = 0.214), anastomosis recurrence (10.94% vs. 19.43%, P = 0.123), and tumor bed recurrence (4.69% vs. 9.71%, P = 0.214) (Table 2)
Summary
The overall 5-year survival rate of esophageal carcinoma is 45.7% [1]. Despite recent advances in minimally invasive oesophagectomy [2], there was no significant improvement in survival. There is no common consensus for postoperative radiotherapy, a growing number of researchers [8,9,10,11] suggest that postoperative radiotherapy, which can reduce local recurrence, was associated with better survival rates for patients with node-positive thoracic esophageal carcinoma (TEC). Latest researchers [12,13,14,15,16] thought supraclavicular, and station 1–5 and 7 lymph nodes should be included in postoperative radiotherapy. In this way, many patients could avoid many adverse effects. We analyzed local regional recurrence patterns of thoracic esophageal carcinoma after three-field lymph node dissection (3-FLD) with and without postoperative radiotherapy, and assessed the postoperative radiation value for local control
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