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Prophylactic Cervical Lymph Node Dissection in Thoracoscopic Esophagectomy for Esophageal Cancer Increases Postoperative Complications and Does Not Improve Survival

  • Yasufumi KoterazawaEmail author
  • Taro Oshikiri
  • Gosuke Takiguchi
  • Hiroshi Hasegawa
  • Masashi Yamamoto
  • Shingo Kanaji
  • Kimihiro Yamashita
  • Takeru Matsuda
  • Tetsu Nakamura
  • Yasuhiro Fujino
  • Masahiro Tominaga
  • Satoshi Suzuki
  • Yoshihiro Kakeji
Gastrointestinal Oncology
  • 43 Downloads

Abstract

Background

Esophagectomy with three-field lymph node dissection is common, but the effects of cervical lymph node dissection on overall survival in patients with thoracic esophageal cancer remain controversial. Recently, we performed thoracoscopic esophagectomy and superior mediastinum and paracervical esophageal lymph nodes could have been effectively dissected from the thoracic cavity. This study assessed the risks and benefits of prophylactic supraclavicular lymph node dissection in patients who underwent thoracoscopic esophagectomy.

Methods

This retrospective study included 294 patients who underwent thoracoscopic esophagectomy at Kobe University Hospital and Hyogo Cancer Center between April 2010 and December 2015. Patients in the two-field (paracervical esophageal lymph nodes were dissected from the thoracic cavity) and three-field lymph node dissection groups were matched using propensity score matching. We compared overall survival and the incidence of postoperative complications in the matched cohort and assessed the estimated efficacy of additional lymphadenectomy for supraclavicular lymph node recurrence in the entire cohort.

Results

In the matched cohort, overall survival was not significantly different between the two groups, but the incidence of recurrent laryngeal nerve palsy was significantly higher in the 3FL group than in the 2FL group. In the entire cohort, 162 patients underwent a two-field lymph node dissection; 11 experienced supraclavicular nodal recurrence. We performed additional supraclavicular lymph node dissection in three patients without systemic metastasis, all of whom are alive without any other recurrence.

Conclusions

Prophylactic cervical lymph nodes dissection in thoracoscopic esophagectomy does not improve long-term survival but does increase the risk of postoperative complications.

Notes

References

  1. 1.
    Jemal A, Murray T, Samuels A, et al. Cancer statistics, 2003. CA Cancer J Clin. 2003;53:5–26.CrossRefGoogle Scholar
  2. 2.
    Wu PC, Posner MC. The role of surgery in the management of esophageal cancer. Lancet Oncol. 2003;4:481–8.CrossRefGoogle Scholar
  3. 3.
    Igaki H, Kato H, Tachimori Y, et al. Clinicopathologic characteristics and survival of patients with clinical stage I squamous cell carcinoma of the thoracic esophagus treated with three-field lymph node dissection. Eur J Cardiothorac Surg. 2001;20:1089–94.CrossRefGoogle Scholar
  4. 4.
    Akutsu Y, Kato K, Igaki H, et al. The prevalence of overall and initial lymph node metastasis in clinical T1N0 thoracic esophageal cancer: from the result of JCOG0502, a prospective multicenter study. Ann Surg. 2016;264:1009–15.CrossRefGoogle Scholar
  5. 5.
    Dresner SM, Griffin SM. Pattern of recurrence following radical esophagectomy with two-field lymphadenectomy. Br J Surg. 2000;87:1426–33.CrossRefGoogle Scholar
  6. 6.
    Mariette C, Balon JM, Peissen G, et al. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer. 2003;97:1616–23.CrossRefGoogle Scholar
  7. 7.
    Law S, Kwont DLM, et al. Two-field dissection is enough for esophageal cancer. Dis Esophagus. 2001;14:98–103.CrossRefGoogle Scholar
  8. 8.
    Watanabe H, Kato H, Tachimori Y. Significance of extended systemic lymph node dissection for thoracic esophageal carcinoma in Japan. Recent Results Cancer Res. 2000;155:123–33.CrossRefGoogle Scholar
  9. 9.
    Ma GW, Situ DR, Ma QL, et al. Three-field vs two-field lymph node dissection for esophageal cancer: a meta-analysis. World J Gastroenterol. 2014;21:18022–30.CrossRefGoogle Scholar
  10. 10.
    Ye T, Sun Y, Zhang Y, Zhang Y, Chen H. Three-field or two-field resection for thoracic esophageal cancer: a meta-analysis. Ann Thoracic Surg. 2013;96:1933–42.CrossRefGoogle Scholar
  11. 11.
    Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine. 2015;94:e1369.CrossRefGoogle Scholar
  12. 12.
    Osugi H, Narumiya K, Kudou K. Supracarinal dissection of the oesophagus and lymphadenectomy by MIE. J Thorac Dis. 2017;9:741–50.CrossRefGoogle Scholar
  13. 13.
    Oshikiri T, Nakamura T, Miura Y, et al. A new method (the “Pincers maneuver”) for lymphadenectomy along the right recurrent laryngeal nerve during thoracoscopic esophagectomy in the prone position for esophageal cancer. Surg Endosc. 2017;31:1496–504.CrossRefGoogle Scholar
  14. 14.
    Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effect. Biometrika. 1983;70:41–55.CrossRefGoogle Scholar
  15. 15.
    Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. Oxford: Blackwell; 2010.Google Scholar
  16. 16.
    Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.CrossRefGoogle Scholar
  17. 17.
    Clavien PA, Barkin J, de Oliveria ML, et al. The Clavien–Dindo classification of surgical complication: five-year experience. Ann Surg. 2009;250:187–96.CrossRefGoogle Scholar
  18. 18.
    Nishihara T, Hirayama K, Mori S, et al. A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg. 1998;175:47–51.CrossRefGoogle Scholar
  19. 19.
    Yoonjin K, Yoohwa H, Hyun-Ju L, et al. Patterns and prognostic significance of cervical lymph node metastasis and the efficacy of cervical node dissection in esophageal cancer. Korean J Thorac Cardiovasc Surg. 2017;50:329–38.CrossRefGoogle Scholar
  20. 20.
    Shim YM, Kim HK, Kim K. Comparison of survival and recurrence pattern between two-field and three-field lymph node dissections for upper thoracic esophageal squamous cell carcinoma. J Thorac Oncol. 2012;5:707–12.CrossRefGoogle Scholar
  21. 21.
    Taniyama Y, Miyata G, Kamei T, et al. Complications following recurrent laryngeal nerve lymph node dissection in oesophageal cancer surgery. Interact Cardiovasc Thorac Surg. 2015;20:41–6.CrossRefGoogle Scholar
  22. 22.
    Deok HL, Hyeong RK, Dong KK, et al. Outcomes of cervical lymph node recurrence in patients with esophageal squamous cell carcinoma after esophagectomy with 2-field lymph node dissection. J Thorac Oncol. 2013;146:365–71.Google Scholar
  23. 23.
    Mine S, Watanabe M, Kumagai K, et al. Oesophagectomy with or without supraclavicular lymphadenectomy after neoadjuvant treatment for squamous cell carcinoma of the oesophagus. Br J Surg. 2018;105:1793–8.CrossRefGoogle Scholar
  24. 24.
    Sihvo E, Helmeinen O, Gunn J, Sipola JOT, Reutava P, Kyoto V. Long-term outcomes following minimally invasive and open esophagectomy in Finland: population-based study. Eur J Surg Oncol.  https://doi.org/10.1016/j.ejso.2018.12.001.Google Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Yasufumi Koterazawa
    • 1
    Email author
  • Taro Oshikiri
    • 1
  • Gosuke Takiguchi
    • 1
  • Hiroshi Hasegawa
    • 1
  • Masashi Yamamoto
    • 1
  • Shingo Kanaji
    • 1
  • Kimihiro Yamashita
    • 1
  • Takeru Matsuda
    • 2
  • Tetsu Nakamura
    • 1
  • Yasuhiro Fujino
    • 3
  • Masahiro Tominaga
    • 3
  • Satoshi Suzuki
    • 4
  • Yoshihiro Kakeji
    • 1
  1. 1.Division of Gastrointestinal Surgery, Department of SurgeryKobe University Graduate School of MedicineKobe CityJapan
  2. 2.Division of Minimally Invasive Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
  3. 3.Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
  4. 4.Division of Community Medicine and Medical Network, Department of Social Community Medicine and Health ScienceKobe University Graduate School of MedicineKobeJapan

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