Korean J Thorac Cardiovasc Surg.  2017 Oct;50(5):329-338. 10.5090/kjtcs.2017.50.5.329.

Patterns and Prognostic Significance of Cervical Lymph Node Metastasis and the Efficacy of Cervical Node Dissection in Esophageal Cancer

• Kang Y
• Hwang Y
• Lee HJ
• Park IK
• Kim YT
• Kang CH

• KMID: 2398388
• DOI: http://doi.org/10.5090/kjtcs.2017.50.5.329

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.

Keyword

Esophageal neoplasms; Neck dissecion

MeSH Terms

Carcinoma, Squamous Cell
Esophageal Neoplasms*
Esophagectomy
Humans
Lymph Node Excision
Lymph Nodes*
Neoplasm Metastasis*
Odds Ratio
Recurrence
Retrospective Studies
Survival Rate