Three-Field Lymphadenectomy in Minimally Invasive Esophagectomy for Squamous Cell Carcinoma

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Thoracic Surgery

Background:

• Minimally invasive esophagectomy (MIE) is a standard treatment for esophageal cancer.
• Optimal lymphadenectomy extent in MIE remains debated.
• Three-field lymphadenectomy (3-FL) versus two-field lymphadenectomy (2-FL) requires further safety and efficacy evaluation.

Purpose of the Study:

• To compare the safety and efficacy of 3-FL versus 2-FL in MIE for esophageal cancer.
• To evaluate the impact of lymphadenectomy extent on perioperative outcomes and staging accuracy.

Main Methods:

• A single-center randomized controlled trial (RCT) enrolled 76 patients with resectable thoracic esophageal cancer.
• Patients were randomized to undergo MIE with either 3-FL or 2-FL.
• Perioperative outcomes, including lymph node yield, complications, and hospital stay, were compared.

Main Results:

• The 3-FL group harvested significantly more lymph nodes (54.7 vs 30.9, P < .001) and identified more metastatic nodes (3.5 vs 1.7, P = .027).
• Final pathologic TNM staging was more advanced in the 3-FL group.
• Operation time was longer in the 3-FL group (270.5 vs 236.7 minutes, P = .002), but major complications and hospital stay were similar.

Conclusions:

• Three-field lymphadenectomy in MIE for esophageal cancer increases lymph node yield and improves staging accuracy.
• 3-FL is a safe and effective approach with comparable perioperative risks to 2-FL.
• Enhanced staging through 3-FL may refine treatment strategies for esophageal cancer.