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Published on: September 11, 2021
Three-field lymph node dissection subsequent to neoadjuvant concurrent chemoradiotherapy in esophageal cancer
Bubse Na1, Chang Hyun Kang1, Ji Hyeon Park1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 101 Daehak-ro Jongno-gu Seoul 03080, South Korea, Republic of Korea.
Background:
In esophageal squamous cell carcinoma, three-field lymph node dissection (3FLND) is not commonly performed after neoadjuvant chemoradiotherapy (nCRT) due to the high morbidity associated with the procedure and the poor long-term survival of patients with cervical/supraclavicular lymph node metastasis. This study aims to evaluate the long-term survival outcomes of patients who underwent 3FLND combined with nCRT.
Methods:
Between 2013 and 2021, patients who underwent esophagectomy and 3FLND after nCRT for advanced thoracic esophageal squamous cell carcinoma, either with (n = 41) or without (n = 65) clinical cervical/supraclavicular lymph node metastasis, were included in this study.
Results:
The Ivor Lewis and McKeown procedures were performed in 22 patients (20.8%) and 84 patients (79.2%), respectively. The rates of major complications (Grade ≥ IIIb) and 90-day mortality were 6.6% and 2.8%, respectively. A pathological complete response was observed in 26 patients (24.5%), whereas residual cervical/supraclavicular lymph node metastasis was identified in 30 patients (28.3%). The five-year overall survival rates for patients with and without preoperative cervical/supraclavicular lymph node metastasis were 51.5% and 41.4%, respectively. Multivariable analysis of survival in patients with preoperative cervical/supraclavicular lymph node metastasis identified residual cervical/supraclavicular lymph node metastasis (hazard ratio [HR] = 7.885, P < 0.001) and major complications (HR = 74.581, P = 0.001) as significant risk factors for overall survival.
Conclusions:
3FLND combined with nCRT can achieve favorable long-term survival even in patients with esophageal cancer and cervical/supraclavicular lymph node metastasis. Downstaging of cervical lymph node metastasis is a key factor in improving survival outcomes for these patients.
