Lymph-node dissection in squamous cell esophageal cancer - who benefits?

Abstract Aim To evaluate the involvement of subcarinal lymph node dissection (SLND) in the surgical treatment of esophageal cancer, as well as its impact on surgical outcomes following esophagectomy. Background & Methods Data on patients that underwent esophagectomy from 01/03/2014 to 01/03/2019 were prospectively collected and retrospectively reviewed. Based on the medical records, the following parameters were collected and analyzed: patient demographics, histopathological parameters, surgical- oncological outcomes. All patients were staged according to the AJCC 8th edition. Results A total of 79 patients underwent Ivor Lewis or McKeown esophagectomy for either squamous cell carcinoma (n= 7 patients) or adenocarcinoma of the esophagus or gastroesophageal junction (n= 72 patients). In 26 cases, esophagectomy was performed without SLND, while 53 cases underwent SLND. Among the 53 patients, 50 (94.3%) were men, and 3 (5.7 %) were women. Mean age was 61.4 years, (range 34-78). Mean nodal harvest was 34.7 lymph nodes per patient. Lymph node invasion was noted in 33 patients (62.2%), with a mean of 9 positive lymph nodes per patient. Subcarinal lymph nodes were involved in 5 out of 53 patients (9.4%). The ratio of positive subcarinal lymph nodes to resected ones was 1/2 (50%), 3/3 (100%), 1/2 (50%), 1/2 (50%) and 1/1 (100%) for each patient. Final histopathological report showed adenocarcinoma of moderate or poor differentiation (G2 2/5, G3 3/5) in all five patients (100%). Four out of 5 patients had not received neoadjuvant treatment and their pathological staging was T3N3M0. One patient had received neoadjuvant chemotherapy and his final staging was ypT3N2M0. Noteworthy, the seven patients diagnosed with squamous carcinoma, were subjected to SLND and were 100% negative for invasion histologically. Conclusion Subcarinal lymph nodes were infiltrated in 9.4% of patients operated for esophageal cancer. In the squamous cell cancer group, the relative infiltration rate was notably 0%. It seems that omission of subcarinal lymph node dissection during transthoracic esophagectomy cannot be justified.

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Pattern of lymph node metastases of squamous cell esophageal cancer based on the anatomical lymphatic drainage system: efficacy of lymph node dissection according to tumor location

Journal of Thoracic Disease ◽

10.21037/jtd.2017.06.19 ◽

2017 ◽

Vol 9 (S8) ◽

pp. S724-S730 ◽

Cited By ~ 14

Author(s):

Yuji Tachimori

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Lymph Node Metastases ◽

Drainage System ◽

Lymphatic Drainage ◽

Tumor Location ◽

Node Dissection ◽

Squamous Cell Esophageal Cancer ◽

Node Metastases

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The Rationale For Performing Hybrid Mediastinal Lymph Node Dissection By Transhiatal Access For Thoracic Esophageal Cancer

International Journal of Pharmaceutical Research ◽

10.31838/ijpr/2021.13.01.291 ◽

2020 ◽

Vol 13 (01) ◽

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Mediastinal Lymph Node ◽

Mediastinal Lymph Node Dissection ◽

Node Dissection ◽

Thoracic Esophageal Cancer

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Prognostic evaluation for squamous cell carcinomas of the lower thoracic esophagus treated with three-field lymph node dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(01)00701-1 ◽

2001 ◽

Vol 19 (6) ◽

pp. 887-893 ◽

Cited By ~ 27

Author(s):

Hiroyasu Igaki ◽

Hoichi Kato ◽

Yuji Tachimori ◽

Hiroshi Sato ◽

Hiroyuki Daiko ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Squamous Cell ◽

Squamous Cell Carcinomas ◽

Thoracic Esophagus ◽

Node Dissection ◽

Prognostic Evaluation

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254 LYMPH NODE DISSECTION IN T1 AND T2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA: MINIMALLY INVASIVE ESOPHAGECTOMY VERSUS OPEN SURGERY

Diseases of the Esophagus ◽

10.1093/dote/doab052.254 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Xiao Teng ◽

Jinlin Cao ◽

Jinming Xu ◽

Cheng He ◽

Chong Zhang ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Lymph Node Dissection ◽

Squamous Cell ◽

Open Surgery ◽

Node Dissection ◽

Invasive Esophagectomy ◽

T1 And T2

Abstract Minimally invasive esophagectomy is increasingly performed for esophageal squamous carcinoma, with advantages of improved perioperative outcomes in comparison with open esophagectomy. Lymph node dissection is one of most important prognostic factors, in esophageal squamous cell carcinoma. It is still unknown whether MIE can meet the criteria of lymph node dissection in the mediastinum, especially in T1 and T2 esophageal cancer. Here, we compared the lymph node dissection between MIE and open surgery. Methods We retrospectively reviewed the clinicopathological data from 147 patients who underwent open surgery and MIE for esophageal squamous cell carcinoma from December 2016 to January 2020. The clinicopathological data including age, gender, number of lymph node resected were analyzed. Results 68 patients underwent MIE and 79 patients underwent open surgery. The number of harvested lymph node didn’t differ between the open surgery group and MIE group (26 ± 11.9 vs 26 ± 13.4, respectively, p = 0.128). However, the number of resected lymph node in the low para-esophageal region was significantly higher in open surgery group (4.1 ± 3.9 vs 2.8 ± 2.6, respectively, p = 0.019). The number of resected lymph node in the upper mediastinal region was significantly higher in the MIE group in T1 and T2 patients (4.7 ± 3.8 vs 2.7 ± 2.9, respectively, p = 0.014). the difference was also noticed in the para-recurrent laryngeal lymph node regions (3.6 ± 2.9 vs 2.0 ± 2.3, respectively, p = 0.020). Conclusion For stages T1 and T2 esophageal squamous cell carcinoma, the lymph node dissection by MIE was comparable to that by open surgery. However, the number of harvested lymph node in the upper mediastinal region was better in the MIE group, which may indicate a better outcome. There was no difference in the postoperative complications, hospital stay and overall survival rate.

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