Lymph node dissection for thoracic esophageal carcinoma. Two- and 3-field lymph node dissection

Area of Science:

• Thoracic oncology
• Surgical oncology
• Esophageal cancer research

Background:

• Thoracic esophageal carcinoma poses significant survival challenges.
• Lymph node status is a critical prognostic factor in esophageal cancer.
• Optimizing surgical management, including lymph node dissection extent, is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the impact of varying lymph node dissection extents on survival in thoracic esophageal carcinoma patients.
• To compare the efficacy and safety of conventional 2-field, extended 2-field, super-extended 2-field, and 3-field lymph node dissections.
• To determine if an expanded lymph node dissection field improves survival without compromising operative safety.

Main Methods:

• Retrospective analysis of patient records undergoing surgical resection for thoracic esophageal carcinoma.
• Exclusion of patients with incomplete tumor resection.
• Comparison of outcomes across four surgical groups: conventional 2-field, extended 2-field, super-extended 2-field, and 3-field lymph node dissections.

Main Results:

• The 3-field dissection (cervical, mediastinal, abdominal) involved a mean of 77 dissected lymph nodes.
• Operative mortality rates were 11% (extended 2-field), 9% (super-extended 2-field), and 3% (3-field dissection).
• Five-year survival rates were significantly higher for extended 2-field (43%) and 3-field (61%) dissections compared to conventional methods. Patients with positive lymph nodes in the 3-field group still had a 47% five-year survival rate.

Conclusions:

• Increasing the extent of lymph node dissection in thoracic esophageal carcinoma significantly improves patient survival.
• The 3-field lymph node dissection offers superior survival benefits compared to 2-field approaches.
• Expanded lymph node dissection can be performed safely, with improved survival rates and acceptable operative mortality.