Yasufumi Koterazawa1, Taro Oshikiri2, Gosuke Takiguchi2, Hiroshi Hasegawa2, Masashi Yamamoto2, Shingo Kanaji2, Kimihiro Yamashita2, Takeru Matsuda3, Tetsu Nakamura2, Yasuhiro Fujino4, Masahiro Tominaga4, Satoshi Suzuki5, Yoshihiro Kakeji2. 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.
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.