Subcarinal lymph node metastasis and strategy of lymphadenectomy in thoracic esophageal carcinoma

Abstract

To assess the metastatic frequency of subcarinal lymph nodes of thoracic esophageal carcinoma and its influencing factors, in order to determine the adequate range of lymph node dissection during esophagectomy. The clinical data from a cohort of 782 patients with thoracic esophageal carcinoma who underwent esophagectomy with lymphadenectomy were analyzed retrospectively with respect to the impact of subcarinal lymph nodes dissection or no dissection on the incidence of postoperative complications. The metastasis rate of subcarinal lymph nodes was 17.5%. The metastasis rates in the upper, middle and lower esophageal carcinomas were 8.3%, 19.1% and 16.2%, respectively (P > 0.05). For T1, T2, T3 and T4, they were 0, 4%, 22.2% and 34%, respectively (P < 0.05). The overall incidence of postoperative complications with and without subcarinal lymph nodes dissection was 19.0% versus 14.6% (P > 0.05), and the incidence of pulmonary complications was 10.3% versus 7.3% (P > 0.05). Thoracic esophageal carcinomas have a high metastasis rate of subcrinal lymph nodes, and subcarinal lymph nodes dissection is not associated with increasing perioperative complications. Therefore, for the thoracic esophageal carcinoma, no matter the tumor site, esophageal cancer length or size, once the tumor invades the outer membrane, routine subcarinal lymph node dissection should be done.