The impact of lymphadenectomy on lymph node recurrence after performing various treatments for esophageal squamous cell carcinoma

BackgroundTreatment for regional lymph node recurrence after initial treatment for esophageal squamous cell carcinoma (ESCC) differs among institutions. Though some retrospective cohort studies have shown that lymphadenectomy for cervical lymph node recurrence is safe and leads to long-term survival, the efficacy remains unclear. In this study, we investigated the long-term outcomes of patients who underwent lymphadenectomy for regional recurrence after treatment for ESCC.Patients and methodsWe retrieved 20 cases in which lymphadenectomy was performed for lymph node recurrence after initial treatment for ESCC in our hospital from January 2003 to December 2016. Initial treatments included esophagectomy, endoscopic resection (ER) and chemoradiotherapy/chemotherapy (CRT/CT). Overall survival (OS) and recurrence-free survival (RFS) after lymphadenectomy were calculated by the Kaplan-Meier method. We also used a univariate analysis with a Cox proportional hazards model to determine factors influencing the long-term outcomes.ResultsThe 5-year OS and RFS of patients who underwent secondary lymphadenectomy for recurrence after initial treatment were 55.0% and 35.3%, respectively. The 5-year overall survival rates of patients who received esophagectomy, ER and CRT/CT as initial treatments, were 45.5%, 80.0% and 50.0%, respectively. The 5-year OS rates of patients with pStage I and pStage II-IVB lymph node recurrence were 75.0% and 41.7%, respectively.ConclusionsLymphadenectomy for regional recurrence after initial treatment for ESCC is effective to some degree. Patients with regional recurrence after initial treatment for Stage I ESCC have a good prognosis; thus, lymphadenectomy should be considered for these cases.

Postoperative recurrence with right cervical lymph node metastasis in hepatocellular carcinoma: a case report

Background Hepatocellular carcinoma (HCC) patients with metastases to the cervical lymph nodes are extremely rare, and its clinical course is characterized by rapidly progressive disease. Hence, there have been no reports of metastatic cervical lymph node recurrence indicated after a long postoperative surveillance period. Case presentation The patient was a 63-year-old male who underwent right hepatectomy for HCC of the right upper lobe. Three years after resection, metastatic lymph node recurrence was detected in the subdiaphragm, superior mediastinum, and right cervical lymph nodes. The patient underwent excisional biopsy of the cervical lymph node, followed by molecular-targeted therapy and radiation therapy. Lenvatinib reduced the size of all metastatic lymph nodes and the patient survived for a relatively long period of 43 months after the recurrence was detected. Conclusions After resection of HCC in the right upper lobe, there is the possibility of metastatic lymph node recurrence in unusual sites, including the cervical region, and lenvatinib may be effective in those recurrences.

Laser Ablation Treatment of Recurrent Lymph Node Metastases from Papillary Thyroid Carcinoma

(1) Background: The incidence of papillary thyroid cancers is increasing. Papillary neoplasm metastasizes to the central and lateral lymph nodes of the neck. The recurrence rate is less than 30%. The gold standard of treatment for lymph node recurrences is surgery, but surgery is burdened by a high rate of complications. Therefore, laser ablation of recurrent lymph nodes has been recognized as an alternative treatment with minimal invasiveness, a low complication rate and a curative effect. (2) Methods: We analyzed 10 patients who underwent a total thyroidectomy and metabolic radiotherapy and who developed a lymph node recurrence in the laterocervical compartment in the following 12–18 months. (3) Results: Patients developed lymph node recurrence at IV and Vb levels in 70% and 30% of cases, respectively. All patients were treated with a single laser ablative session. Hydrodissection was performed in all patients. The energy delivered was 1120 ± 159.3 Joules and 3–4 Watts in 362 ± 45.7 s. No complications were reported. All patients underwent a 6-month follow-up. A volumetric reduction of 40.12 ± 2.2%, 49.1 ± 2.13% and 59.8 ± 3.05%, respectively at 1-, 3- and 6-months of follow-up was reported. (4) Conclusions: At 6 months, a fine needle aspiration was performed, which was negative for malignant cells and negative for a dosage of Thyroglobulin in eluate. The laser ablation is an effective alternative to surgical treatment.

308 PROGNOSTIC FACTORS OF PATIENTS WITH LYMPH NODE RECURRENCE AFTER ESOHAGECTOMY

Background: Lymph node recurrence (LNrec) is a frequent form of recurrence in esophageal squamous cell carcinoma (ESCC), but is often characterized as a systemic disease. However, loco-regional treatment may provide cure for lymph node-only recurrence without distant metastases. There is no consensus on the outcome of multidisciplinary treatment, including surgical resection. The aim of this study is to identify the prognostic factors and to establish treatment strategy for LNrec. Methods Methods: Among 1160 patients who underwent esophagectomy for ESCC between 2004 and 2017 in our hospital, 117 patients (12.4%) who had LN-only recurrence without distant recurrence were analyzed retrospectively. The standard operation consisted of subtotal esophagectomy with 2- or 3-field lymph node dissection via right thoracotomy or video assisted thoracic surgery (VATS) and gastric tube reconstruction. Recurrence site, treatment for LN rec, and survival after recurrence were examined. Survival curves were plotted using the Kaplan–Meier method, and differences between survival curves were compared using the log-rank Test. Results The 3-year survival rate after recurrence of all lymph node-only cases was 19.5%. The 3-year survival rate after recurrence was significantly better in patients with single recurrence: 25.1%/multiple recurrence 12.4% (p = 0.0222). The 3-year survival rate after recurrence was initial p-stage: II or lower/III or higher = 39.0/14.1% (p = 0.0107). Patients with a high p-stage at initial surgery had a significantly poor prognosis. Patients who underwent local treatment (C RT or surgery) after recurrence had significantly better prognosis than those who did not (25.8/10.6%; p = 0.0006). Conclusion Single LN rec, low initial p-stage, local treatment (CRT or surgery) were identified as prognostic factors in patients with LN-only recurrence.