Optimal lymph node dissection thresholds for early-stage esophageal squamous cell carcinoma: a retrospective...

Area of Science:

• Oncology
• Surgical Oncology
• Thoracic Surgery

Background:

• Esophageal cancer (EC), particularly ESCC in China, is a leading cause of cancer mortality.
• Optimal lymph node (LN) dissection extent for early-stage EC based on tumor location is not well-defined.
• This study addresses the need for location-specific LN dissection guidelines in clinical T1-2N0M0 ESCC.

Purpose of the Study:

• To establish location-specific lymph node (LN) dissection thresholds for esophageal squamous cell carcinoma (ESCC).
• To improve survival outcomes for patients with clinical T1-2N0M0 ESCC.
• To provide evidence-based guidance for surgeons on tailoring LN dissection strategies.

Main Methods:

• Retrospective analysis of 1017 patients undergoing esophagectomy (March 2015 - December 2018).
• Lymph nodes categorized into upper mediastinal (UM), middle mediastinal (MM), lower mediastinal (LM), and abdominal (Abd) compartments.
• Maximally Selected Rank Statistics used for optimal cut-off values; survival analyzed by Kaplan-Meier and Cox regression.

Main Results:

• Dissection of ≥17 total LNs, including ≥1 LM LN and ≥14 Abd LNs, correlated with improved survival.
• Location-specific recommendations: upper thoracic (≥19 total LNs, ≥5 UM, ≥14 Abd), middle thoracic (≥17 total LNs, ≥1 LM, ≥6 Abd), lower thoracic (≥18 total LNs, ≥9 UM, ≥1 LM).
• Total LNs and LM LNs were independent prognostic factors for overall survival; subgroup analyses identified RLNs as significant.

Conclusions:

• Defined location-specific lymph node dissection thresholds can enhance survival in clinical T1-2N0M0 ESCC.
• These findings offer surgeons evidence-based recommendations for optimizing lymph node dissection based on tumor location.
• Tailored lymph node dissection strategies are crucial for improving prognoses in early-stage ESCC.