Abstract
BackgroundThe extent of node dissection in esophageal cancer surgery is usually estimated by the number of resected nodes, irrespective of the area of dissection. The efficacy of lymph node dissection by area was evaluated according to the location of the primary tumor.MethodsThe study group comprised the 3827 patients who underwent R0 esophagectomy with three-field lymph node dissection for squamous cell carcinoma, registered in a nationwide registry in Japan. The areas of lymph node were classified into zones according to AJCC Staging Manual. The Efficacy Index (EI) calculating the frequency and patient survival of metastases to each zone was investigated according to tumor location.ResultsThe EI was high in supraclavicular and upper mediastinal zones in patients with upper esophageal tumors, highest in upper mediastinal zone followed by supraclavicular and perigastric zones in patients with middle esophageal tumors, and highest in perigastric zone followed by upper and lower mediastinal zones in patients with lower esophageal tumors. In patients with middle and lower esophageal cT1 tumors, the EIs of upper mediastinal and perigastric zones were higher than middle and lower mediastinal zones.ConclusionThe EIs of each zone were differed by tumor location. The extent of lymph node dissection should be estimated by the dissected zones and modified by the tumor location. Supraclavicular dissection is indispensable for patients with upper esophageal tumors, and recommended for patients with middle esophageal tumors. Upper mediastinal dissection is recommended for all patients with thoracic esophageal squamous cell carcinoma, irrespective of the location.
Highlights
Despite recent advances in multidisciplinary approaches, surgical resection remains the standard treatment for potentially resectable esophageal carcinoma
Upper mediastinal dissection is recommended for all patients with thoracic esophageal squamous cell carcinoma, irrespective of the location
The purpose of this retrospective study was to evaluate the efficacy of lymph node dissection by the area based on the location of the primary tumor, calculating the frequency and patient survival of metastases to the area in patients with thoracic esophageal squamous cell carcinoma who underwent esophagectomy with curative intent
Summary
Despite recent advances in multidisciplinary approaches, surgical resection remains the standard treatment for potentially resectable esophageal carcinoma. The extent of lymph node dissection in esophageal cancer surgery is estimated by the number of resected regional lymph nodes, irrespective of the area of dissection [2]. Many surgeons accept that the area of nodal dissection should be modified according to the location of the primary tumor in an individual patient. The purpose of this retrospective study was to evaluate the efficacy of lymph node dissection by the area based on the location of the primary tumor, calculating the frequency and patient survival of metastases to the area in patients with thoracic esophageal squamous cell carcinoma who underwent esophagectomy with curative intent. Upper mediastinal dissection is recommended for all patients with thoracic esophageal squamous cell carcinoma, irrespective of the location
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