Abstract
Background
Supraclavicular lymph nodes (No 104) were upgraded from group 3 to group 2, which needs to be dissected in D2 surgery, for tumors located in middle thoracic esophagus in the 11th edition of Japanese classification of esophageal cancer. However, it is not based on prospective study and the evidence level remains moderate. Current evidence regarding supraclavicular lymphadenectomy is mainly based on retrospective cohort study of efficacy index without proper control. The aim of this study is to retrospectively investigate the clinical impact of supraclavicular lymphadenectomy for middle esophageal cancer.
Methods
A total of 240 consecutive patients who underwent R0 esophageal resection for clinical Stage I, II, III (UICC 8th) primary esophageal squamous cell carcinoma from 2005 to 2017 in Kyoto University Hospital were investigated. Patients who underwent salvage surgery after definitive chemoradiotherapy were excluded. Among them, 99 patients had middle esophageal cancer. All patients underwent at least abdominal and mediastinal lymphadenectomy including cervical paraesophageal (No 101) and paratracheal (No 106rec) nodes. After propensity score matching, 42 patients (21 each for with (3F) and without (2F) supraclavicular lymphadenectomy) were selected for comparison.
Results
In the propensity-matched population (n = 42), the 5-year overall survival of clinical Stage I (n = 15)/II (n = 9)/III (n = 18) was 100%/52%/57%. Though cStage, neoadjuvant therapy, ASA-PS and date of surgery (early, middle and late period) were well matched, the 5-year overall survival in 2F and 3F were 82% and 68%. The hazard ratio (3F/2F) for overall death was 2.6 (95% CI, 0.79–9.97; P = 0.1178). In terms of short term outcomes, postoperative morbidity graded as Clavien-Dindo grade 2 or higher was 48% in the both group, while respiratory complication (Clavien-Dindo grade 2 or higher) was 14% in 2F and 29% in 3F, respectively. The odds ratio was 2.4 (95% CI, 0.51–11.3; P = 0.2593).
Conclusion
This observational study failed to show any clinical benefit of supraclavicular lymphadenectomy. Given the nature of retrospective study, there might be overlooked confounding factors to select 2F or 3F. Further prospective study is warranted.
Disclosure
All authors have declared no conflicts of interest.
Role of chemotherapy after curative esophagectomy in squamous cell carcinoma of the thoracic esophagus: A propensity score‐matched analysis
