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

Thymic tumors are the most common primary neoplasms of the anterior mediastinum, although, when compared with the entire thoracic malignancies, they are still rare. Few studies addressed the questions about lymph node involvement pattern in thymic neoplasms, about which subgroup of patients would be appropriate candidates for lymph node dissection or about the extent of lymphadenectomy or which lymph nodes should be harvested. The aim of this review is to collect evidence from the literature to help physicians in designing the best surgical procedure when dealing with thymic malignancies. A literature review was performed through PubMed and Scopus in May 2021 to identify any study published in the last 20 years evaluating the frequency and the extent of lymph node dissection for thymic tumors, its impact on prognosis and on postoperative management. Fifteen studies met the inclusion criteria and were included in this review, with a total of 9452 patients with thymic cancers; lymph node metastases were found in 976 (10.3%) patients in total. The current literature is heterogeneous in the classification and reporting of lymph node metastases in thymic carcinoma, and data are hardly comparable. Surgical treatment should be guided by the few literature-based pieces of evidence and by the experience of the physicians.

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RA09.07: SURGICAL MANAGEMENT OF EARLY ESOPHAGEAL CANCER BASED ON LYMPH NODE METASTASIS RISK.

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra09.07 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 41-41

Author(s):

Xiaofeng Duan ◽

Zhentao Yu

Keyword(s):

Risk Factors ◽

Esophageal Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Tumor Location ◽

Individual Risk ◽

Node Dissection ◽

Early Esophageal Cancer ◽

Node Metastasis ◽

The Individual

Abstract Background Esophagectomy and lymph node dissection is still the main treatment for esophageal cancer. Endoscopic mucosal resection and submucosal dissection are increasingly becoming a treatment of choice to preserve the integrity of the esophagus and decrease the surgical trauma in early esophageal cancer. However, lymph node metastasos (LNM) risk is still a debate focus for the decision of treatment selection. Our objective was to evaluate the prevalence, pattern and risk factors of LNM in early stage esophageal cancer to improve surgical treatment allocation. Methods We identified patients with pathological T1 stage esophageal cancer who underwent esophagectomy and lymph node dissection. The pattern of LNM was analyzed and the risk factors related to LNM were assessed by univariate and multivariable logistic regression analysis.The nomogram model was used to estimate the individual risk of lymph node metastasis. Results In 143 patients, LNM rates were: all patients 17.5%, T1a 8.0%, and T1b 22.5% for T1b. Depth of tumor infiltration (P < 0.05), tumor size (P < 0.01), tumor location (P < 0.05), and tumor differentiation (P < 0.01) were independent risk factors related to LNM. These four parameters allowed the compilation of a nomogram to estimate the individual risk of LNM. Fig. Nomogram to estimate the individual risk of LNM. Each characteristic of the included parameters scores a specific number of points (points per parameter). The summarized total points score indicates the probability of LNM. For a middle esophageal cancer with middle differentiated (G2), 3 cm tumor (> 2.5cm) that invades the submucosa (pT1b), the calculated total scores is 129.5 = 87.5 + 21 + 0 + 21, hence the corresponding LNM risk is 20%. Conclusion T1 esophageal cancer has a relatively high LNM rate, and the depth of tumor infiltration, tumor size, tumor location and tumor differentiation are correlated with LNM. Nomograms that include factors can be used to predict individual LNM risk. The LNM risk and extent must be considered comprehensively in decision-making of a better surgical treatment and lymph node dissection strategy. Disclosure All authors have declared no conflicts of interest.

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