Patterns and Prognostic Significance of Cervical Lymph Node Metastasis and the Efficacy of Cervical Node Dissection in Esophageal Cancer.
10.5090/kjtcs.2017.50.5.329
- Author:
Yoonjin KANG
1
;
Yoohwa HWANG
;
Hyun Ju LEE
;
In Kyu PARK
;
Young Tae KIM
;
Chang Hyun KANG
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea. chkang@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Esophageal neoplasms;
Neck dissecion
- MeSH:
Carcinoma, Squamous Cell;
Esophageal Neoplasms*;
Esophagectomy;
Humans;
Lymph Node Excision;
Lymph Nodes*;
Neoplasm Metastasis*;
Odds Ratio;
Recurrence;
Retrospective Studies;
Survival Rate
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2017;50(5):329-338
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The clinical value of 3-field lymph node dissection (3FLND) in esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to identify the patterns and prognostic significance of cervical lymph node metastasis (CLNM) in ESCC. METHODS: A retrospective review of 77 patients with ESCC who underwent esophagectomy and 3FLND between 2002 and 2016 was conducted. For each cervical node level, the efficacy index (EI), overall survival, recurrence rate, and complication rate were compared. RESULTS: CLNM was identified in 34 patients (44.2%) who underwent 3FLND. Patients with CLNM had a significantly lower overall survival rate (22.7% vs. 58.2%) and a higher recurrence rate (45.9% vs. 16.3%) than patients without CLNM. CLNM was an independent predictor of recurrence in ESCC patients. Moreover, in patients with pathologic N3 tumors, the odds ratio of CLNM was 10.8 (95% confidence interval, 2.0 to 57.5; p= 0.005). Level IV dissection had the highest EI, and level IV metastasis was significantly correlated with overall survival (p=0.012) and recurrence (p=0.001). CONCLUSION: CLNM was a significant prognostic factor for ESCC patients and was more common among patients with advanced nodal stages. Level IV exhibited the highest risk of metastasis, and dissection at level IV may be crucial when performing 3FLND, especially in advanced nodal stage disease.
