Comparison of long-term outcomes of 2.5- and 3-field lymph node dissections for esophageal squamous cell carcinoma
Maohui Chen1, Taidui Zeng1, Yizhou Huang1
1Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China; National Key Clinical Specialty of Thoracic Surgery, Fuzhou, China; Clinical Research Center for Thoracic Tumors of Fujian Province, Fuzhou, China.
Objectives:
Previous studies demonstrated that the mesoesophageal suspension technique is safe and effective for thoracoscopic lymph node dissection in esophageal squamous cell carcinoma (ESCC), but direct comparison with 3-field dissection is lacking. This study aimed to compare 2.5- and 3-field lymph node dissections in terms of survival benefits, recurrence patterns, and complications in patients with ESCC.
Methods:
This was a retrospective study of patients with ESCC who underwent 2.5- or 3-field lymph node dissection (FLD). The outcomes included 30-day mortality, postoperative complications, overall survival (OS), disease-free survival (DFS), and recurrence pattern.
Results:
A total of 353 patients with ESCC were included in this study. After propensity score matching, the frequency of all complications (27.8 % vs. 18.3 %, P = 0.072), recurrent laryngeal nerve injury (5.6 % vs. 0.8 %, P = 0.033) and respiratory complications (19.8 % vs. 11.9 %, P = 0.084) was higher in the 3-field group compared with the 2.5-field group. Smaller number of dissected lymph nodes (median, 31.5 vs. 41, P < 0.001) but comparable number of metastatic lymph nodes (median, 0 vs. 1, P = 0.143) was found in the 2.5-field group compared with the 3-field group. The rate of positive supraclavicular lymph nodes was 1.6 % in the 3-field group. There were no differences OS and DFS between the two groups, with median OS and DFS not reached in both groups. Recurrence pattern of all stage patients was similar between the two groups.
Conclusion:
The 2.5- and 3-FLD have comparable survival benefits for patients with ESCC, while the 2.5-FLD has a lower risk of complications.
