Optimized lymph node dissection range during progression of lower thoracic esophageal squamous cell carcinoma in the latest therapeutic surgical strategy: A retrospective analysis.

Hiroki Harada,Masahiko Watanabe,Akira Ema,Keishi Yamashita,Marie Washio,Hiromitsu Moriya,Yoshimasa Kosaka,Kei Hosoda,Hiroaki Mieno

doi:10.3892/ol.2018.9030

Hiroki Harada, Masahiko Watanabe + Show 7 more

Open Access

https://doi.org/10.3892/ol.2018.9030

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Journal: Oncology letters	Publication Date: Jun 27, 2018
Citations: 4	License type: cc-by

Affiliation: Kitasato University

Abstract

The distribution of lymph node metastases, including recurrences, remains elusive in lower thoracic esophageal squamous cell carcinoma (LtESCC). The present study was a retrospective investigation into the optimized lymph node dissection range during LtESCC. Esophagectomies were performed on 163 patients with ESCC between 2009 and 2016, among whom 41 patients with LtESCC were examined. The rates of pathological and potential (including recurrences) metastases to lymph nodes and the prognosis (median, 34 months) were determined. Preoperative Docetaxel, Cisplatin and 5-fluorouracil chemotherapy was administered in >60% of cStage II/III LtESCC. During stage progression, abdominal lymph node metastasis rapidly becomes aggressive in LtESCC and lymph node metastases to the para-aortic area were more dominant than cervical and recurrent laryngeal nerve (RLN) areas. There were few control failures of regional lymph node metastases in LtESCC with surgery, if 1 unique case with cStage III who had metastases and recurrences of multiple lymph nodes during the clinical course was excluded. Defective lymph node dissection around the RLN did not worsen LtESCC prognosis with no RLN palsy. In the context of the potent preoperative chemotherapy and esophagectomy, lymph node dissection of cervical, para-aortic and RLN areas are putatively not mandatory to all LtESCC patients.

Highlights

In Japan, esophageal squamous cell carcinoma (ESCC) is located in the middle thoracic esophagus (Mt) region (51.6%), lower thoracic esophagus (Lt) region (24.2%), upper thoracic esophagus (Ut) region (13.4%), abdominal thoracic esophagus (Ae) region (4.5%), and cervical esophagus (Ce) region (4.0%) [1]
Another study questioned whether three‐field lymph node dissection contributed to better overall survival (OS) in whole lower thoracic esophageal squamous cell carcinoma (LtESCC) patients [4]
Among the 464 thoracic esophageal cancer, esophagectomy was recommended to be performed with curative intent in 163 cases (35.1%) of the thoracic ESCC cases; the remaining 301 cases (64.9%) did not have surgical treatment

Summary

Introduction

In Japan, esophageal squamous cell carcinoma (ESCC) is located in the middle thoracic esophagus (Mt) region (51.6%), lower thoracic esophagus (Lt) region (24.2%), upper thoracic esophagus (Ut) region (13.4%), abdominal thoracic esophagus (Ae) region (4.5%), and cervical esophagus (Ce) region (4.0%) [1]. There have been only a few reports of the distribution of lymph node metastases in cases of lower thoracic ESCC (LtESCC). LtESCC leads to significantly higher lymph node metastases to the abdomen than to any other location [2]. A previous study reported that three‐field lymph node dissection improved 5‐year overall survival (OS) rates in LtESCC patients [3]. Another study questioned whether three‐field lymph node dissection contributed to better OS in whole LtESCC patients [4]. In LtESCC patients, metastases to para‐aortic lymph nodes are observed in 25.5% of cases. Para‐aortic lymph node dissection should have been considered in cases of positive perigastric lymph node metastases [5]. Poor patient prognosis has been observed in LtESCC patients with positive recurrent laryngeal nerve (RLN) lymph node metastases [6]

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