Esophageal squamous cell carcinoma patients with positive lymph nodes benefit from extended radical lymphadenectomy

The usefulness of lymphadenectomy for advanced esophageal cancer is unclear. A post-hoc subgroup analysis involving a randomized controlled trial was performed to compare the long-term survival of patients with esophageal cancer and lymph nodes metastasis (LNM) after extended lymphadenectomy via the right thoracic approach with that of those undergoing limited lymphadenectomy via the left thoracic approach.

Between May 2010 and July 2012, 300 patients with thoracic esophageal cancer were randomized to undergo esophagectomy through either the right or left thoracic approach. Of these patients, 129 with esophageal squamous cell carcinoma and LNM by postoperative pathology were included in this analysis. Disease-free survival and overall survival (OS) were compared between the extended (n = 64) and limited (n = 65) lymphadenectomy groups after 5 years' follow-up. Cox regression analysis was used to identify the factors associated with OS.

The 5-year disease-free survival rates were 40% and 26% in the extended and limited lymphadenectomy groups, respectively (hazard ratio [HR], 1.542; 95% confidence interval [CI], 1.018-2.335; P = .037), and the 5-year OS rates were 51% and 31%, respectively (HR, 1.719; 95% CI, 1.111-2.660; P = .013). The extended lymphadenectomy group had less locoregional recurrence (HR, 0.583; 95% CI, 0.375-0.908; P = .015) and delayed distant metastasis (HR, 1.407; 95% CI, 0.914-2.167; P = .115). Reduced OS was associated with limited lymphadenectomy, R1/2 resection margins, TNM stage IV, and lack of postoperative adjuvant therapy, as per the Cox regression analysis.

Improved long-term survival was observed in patients with esophageal squamous cell carcinoma and LNM after extended lymphadenectomy via the right thoracic approach.