Abstract
BackgroundThe aim of the present study was to evaluate subcarinal lymph node dissection in transmediastinal radical esophagectomy and subcarinal lymph node metastasis in patients with esophageal cancer.MethodsThree hundred and twenty-three patients with primary esophageal cancer who underwent transmediastinal or transthoracic esophagectomy with radical two- or three-field lymph node dissection were retrospectively investigated. The clinicopathological characteristics of patients with subcarinal lymph node metastasis were analyzed in detail.ResultsThe median of dissected subcarinal lymph nodes in transmediastinal and transthoracic esophagectomy groups was 6 and 7, respectively, and there was no significant difference between the two groups (p = 0.12). Of all patients, 26 (8.0%) were pathologically diagnosed as positive for subcarinal lymph node metastasis, whereas only 7 (26.9%) of those with metastasis were preoperatively diagnosed as positive. In addition, all patients with subcarinal lymph node metastasis had other non-subcarinal lymph node metastasis. By univariate analysis, subcarinal lymph node metastasis was found in larger (≥ 30 mm) and deeper (T3/T4a) primary lesions (p = 0.02 and 0.02, respectively), but it was not found in 49 patients with the primary lesion located in the upper thoracic esophagus.ConclusionsSubcarinal lymph nodes can be dissected in transmediastinal esophagectomy, almost equivalent to transthoracic esophagectomy. The tumor size, depth, and location may be predictive factors for subcarinal lymph node metastasis.
Highlights
Esophageal cancer (EC) is the eighth-most common malignancy and the sixth-leading cause of cancer-related death worldwide [1]
Clinical and pathological staging were performed using the 8th edition of the Union for International Cancer Control (UICC) tumor, nodes, and metastases (TNM) staging [9], and the 11th edition of the Japanese Classification of Esophageal Cancer (JCEC) was used for detailed classification of regional lymph nodes (LNs) [10, 11]
No significant differences were found between the groups in sex, body mass index, clinical diagnosis, and tumor size, while there were significant differences in age, preoperative treatment, and histological type
Summary
Esophageal cancer (EC) is the eighth-most common malignancy and the sixth-leading cause of cancer-related death worldwide [1]. Esophageal squamous cell carcinoma (ESCC) is the common histological type of EC in Japan and Asia. It spreads at an early stage through abundant lymphatic. The aim of the present study was to evaluate subcarinal lymph node dissection in transmediastinal radical esophagectomy and subcarinal lymph node metastasis in patients with esophageal cancer. Methods Three hundred and twenty-three patients with primary esophageal cancer who underwent transmediastinal or transthoracic esophagectomy with radical two- or three-field lymph node dissection were retrospectively investigated. Results The median of dissected subcarinal lymph nodes in transmediastinal and transthoracic esophagectomy groups was 6 and 7, respectively, and there was no significant difference between the two groups (p = 0.12). The tumor size, depth, and location may be predictive factors for subcarinal lymph node metastasis
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