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Optimizing lymph node dissection for accurate nodal staging in early-stage esophageal squamous cell carcinoma: a
Seong Yong Park1, Boram Park2, Jae Kwang Yun3
1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Background:
To confirm the accurate pN0 status in patients with cT1-2N0 esophageal squamous cell carcinoma (ESCC) and recommend an optimal lymph node (LN) count for accurate nodal staging.
Methods:
A total of 1855 patients who underwent upfront surgery for cT1-2N0 ESCC at two tertiary academic hospitals in Korea between 1995 and 2019 were included. The probability of false-negative lymphadenectomy and the Nodal Staging Score (NSS) were calculated to assess adequate staging.
Results:
The mean age was 63.4 ± 8.0 years, with 93.1% male patients. The mean number of dissected LNs was 34.7 ± 14.0. The clinical T stages were cTis and cT1a 354 (19.1%), cT1b 1,053 (56.8%), and cT2 448 (24.2%). Pathological nodal upstaging occurred in 448 (24.2%) patients, with 337 (18.2%) pN1, 94 (5.1%) pN2, and 17 (0.9%) pN3. The analysis indicated that removing fewer than 33 LNs was associated with a 20% risk of missing metastatic nodes, whereas dissecting 53 nodes reduced this risk to 10%. Although overall survival improved with an increasing number of dissected LNs, the benefits plateaued beyond 33 LNs. The NSS, which indicates the likelihood that a patient with pN0 truly has no occult nodal disease, increased with the number of LNs dissected.
Conclusions:
We recommend extensive dissection of at least 33 LNs during esophagectomy for accurate staging and to minimize the risk of undetected positive LNs in early-stage ESCC.
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