Πέμπτη 16 Ιανουαρίου 2020

Esophageal Squamous Cell Carcinoma

2019 Sep;26(9):2899-2904. doi: 10.1245/s10434-019-07499-1. Epub 2019 Jun 11.

Prophylactic Cervical Lymph Node Dissection in Thoracoscopic Esophagectomy for Esophageal Cancer Increases Postoperative Complications and Does Not Improve Survival.

Koterazawa Y1, Oshikiri T2, Takiguchi G2, Hasegawa H2, Yamamoto M2, Kanaji S2, Yamashita K2, Matsuda T3, Nakamura T2, Fujino Y4, Tominaga M4, Suzuki S5, Kakeji Y2.

Author information

1: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan. ya.kote1128@gmail.com.
2: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan.
3: Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
4: Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Japan.
5: Division of Community Medicine and Medical Network, Department of Social Community Medicine and Health Science, Kobe University Graduate School of Medicine, Kobe, Japan.

Abstract

BACKGROUND:

Esophagectomy with three-field lymph node dissection is common, but the effects of cervical lymph node dissection on overall survival in patients with thoracic esophageal cancer remain controversial. Recently, we performed thoracoscopic esophagectomy and superior mediastinum and paracervical esophageal lymph nodes could have been effectively dissected from the thoracic cavity. This study assessed the risks and benefits of prophylactic supraclavicular lymph node dissection in patients who underwent thoracoscopic esophagectomy.

METHODS:

This retrospective study included 294 patients who underwent thoracoscopic esophagectomy at Kobe University Hospital and Hyogo Cancer Center between April 2010 and December 2015. Patients in the two-field (paracervical esophageal lymph nodes were dissected from the thoracic cavity) and three-field lymph node dissection groups were matched using propensity score matching. We compared overall survival and the incidence of postoperative complications in the matched cohort and assessed the estimated efficacy of additional lymphadenectomy for supraclavicular lymph node recurrence in the entire cohort.

RESULTS:

In the matched cohort, overall survival was not significantly different between the two groups, but the incidence of recurrent laryngeal nerve palsy was significantly higher in the 3FL group than in the 2FL group. In the entire cohort, 162 patients underwent a two-field lymph node dissection; 11 experienced supraclavicular nodal recurrence. We performed additional supraclavicular lymph node dissection in three patients without systemic metastasis, all of whom are alive without any other recurrence.

CONCLUSIONS:

Prophylactic cervical lymph nodes dissection in thoracoscopic esophagectomy does not improve long-term survival but does increase the risk of postoperative complications.