Abstract
BackgroundClinically, there are no clear guidelines on the extent of lymphadenectomy in patients with T1 esophageal cancer. Studying the minimum number of lymph nodes for resection may increase cancer-specific survival.MethodsPatients who underwent esophagectomy and lymphadenectomy at T1 stage were selected from the Surveillance, Epidemiology and End Results Program (United States, 1998–2014). Maximally selected rank and Cox proportional hazard models were used to examine three variables: the number of lymph nodes examined, the number of negative lymph nodes and the lymph node ratio.ResultsApproximately 18% had lymph node metastases, where the median values were 10, 10 and 0 for the number of lymph nodes examined, the number of negative lymph nodes and the lymph node ratio, respectively. All three examined variables were statistically associated with cancer-specific survival probability. Dividing patients into two groups shows a clear difference in cancer-specific survival compared to four or five groups for all three variables: there was a 29% decrease in the risk of death with the number of lymph nodes examined ≥14 vs < 14 (hazard ratio 0.71, 95% confidence interval: 0.57–0.89), a 35% decrease in the risk of death with the number of negative lymph nodes ≥13 vs < 13 (hazard ratio 0.65, 95% confidence interval: 0.52–0.81), and an increase of 1.21 times in the risk of death (hazard ratio 2.21, 95% confidence interval: 1.76–2.77) for the lymph node ratio > 0.05 vs ≤ 0.05.ConclusionsThe extent of lymph node dissection is associated with cancer-specific survival, and the minimum number of lymph nodes that need to be removed is 14. The number of negative lymph nodes and the lymph node ratio also have prognostic value after lymphadenectomy among T1 stage patients.
Highlights
There are no clear guidelines on the extent of lymphadenectomy in patients with T1 esophageal cancer
The National Comprehensive Cancer Network (NCCN) guidelines recommend that a minimum of 15 lymph nodes should be removed and examined [1]; for therapeutic purposes, the extent of lymphadenectomy remains under debate, especially in patients with T1 esophageal cancer
Lymph node metastases are thought to be very rare in patients with early esophageal cancer, but studies have shown that the prevalence of lymph node metastases in T1 patients ranges from 16.6% to nearly 40% depending on different histopathological characteristics [2,3,4,5,6]
Summary
There are no clear guidelines on the extent of lymphadenectomy in patients with T1 esophageal cancer. The National Comprehensive Cancer Network (NCCN) guidelines recommend that a minimum of 15 lymph nodes should be removed and examined [1]; for therapeutic purposes, the extent of lymphadenectomy remains under debate, especially in patients with T1 esophageal cancer. Lymph node metastasis is a common mechanism of cancer progression in esophageal cancer. Lymph node metastases are thought to be very rare in patients with early esophageal cancer, but studies have shown that the prevalence of lymph node metastases in T1 patients ranges from 16.6% to nearly 40% depending on different histopathological characteristics [2,3,4,5,6]. Lymph node metastasis is known to influence the prognosis of esophageal cancer. Esophagectomy is the standard treatment for early stage patients, but surgeons still debate the prognosis of the extent of lymph node dissection [7,8,9,10], and the extent of lymph node dissection is still unclear in T1 patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
