[A clinicopathological study on extensive lymph node dissection for thoracic esophageal cancer]

Area of Science:

• Oncology
• Surgical Oncology
• Thoracic Surgery

Background:

• Esophageal cancer necessitates effective surgical strategies.
• Lymph node metastasis is a critical prognostic factor in thoracic esophageal cancer.
• The extent of lymph node dissection impacts patient outcomes.

Purpose of the Study:

• To evaluate the clinical efficacy of extensive lymph node dissection in patients undergoing esophagectomy for thoracic esophageal cancer.
• To analyze the relationship between lymph node metastasis patterns and postoperative recurrence.
• To determine the survival benefit of extensive lymph node dissection based on the number of metastatic lymph nodes and regions involved.

Main Methods:

• Retrospective review of 78 patients who underwent esophagectomy with extensive lymph node dissection.
• Analysis of pathological invasion depth, lymph node metastasis status, operative/hospital death rates, and survival rates.
• Evaluation of postoperative recurrence patterns and correlation with lymph node burden and dissection regions.

Main Results:

• The operative death rate was 2.8% and hospital death rate was 5.1%.
• Lymph node metastasis was present in 65% of cases, with significant involvement in cervical, mediastinal, and abdominal regions.
• Three-year survival rates varied by invasion depth, with an overall rate of 55.3%.
• Postoperative recurrence occurred in 50% of cases, primarily distant organ metastasis (58%) and lymph node metastasis (21%).
• Extensive lymph node dissection improved disease-free interval and survival in cases with recurrence and lymph node metastasis.
• Recurrence was universal in patients with >6 metastatic nodes or metastasis in >2 regions.
• Survival rates improved with extensive lymph node dissection for patients with <5 metastatic nodes and metastasis in <2 regions.

Conclusions:

• Extensive lymph node dissection is a valuable surgical approach for thoracic esophageal cancer.
• The number of metastatic lymph nodes and the number of affected regions are crucial indicators for predicting recurrence and guiding treatment intensity.
• This surgical strategy offers survival benefits, particularly for patients with a lower burden of lymph node metastasis.