Optimal Range of Lymphadenectomy in Pathological Stage T1 and T2 Esophageal Squamous Cell Carcinoma

Hansheng Wu; Weitao Zhuang; Shujie Huang; Xueting Guan; Yuju Zheng; Zefeng Xie; Gang Chen; Jiming Tang; Haiyu Zhou; Liang Xie; Xiaosong Ben; Zihao Zhou; Zijun Li; Rixin Chen; Guibin Qiao

doi:10.3389/fonc.2021.619556

Optimal Range of Lymphadenectomy in Pathological Stage T1 and T2 Esophageal Squamous Cell Carcinoma

Front Oncol. 2021 May 25:11:619556. doi: 10.3389/fonc.2021.619556. eCollection 2021.

Authors

Hansheng Wu^{1

2}, Weitao Zhuang^{2

3}, Shujie Huang^{2

3}, Xueting Guan¹, Yuju Zheng¹, Zefeng Xie¹, Gang Chen², Jiming Tang², Haiyu Zhou², Liang Xie², Xiaosong Ben², Zihao Zhou², Zijun Li², Rixin Chen^{2

4}, Guibin Qiao^{2

3}

Affiliations

¹ Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
² Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ Shantou University Medical College, Shantou, China.
⁴ Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Abstract

Background: Lymph node metastasis is a primary contributor to tumor progression in esophageal squamous cell carcinoma (ESCC), and the optimal extent of lymphadenectomy during esophagectomy remains controversial. This study aimed to investigate the appropriate number of lymph nodes to be dissected in pT1-2Nany stage ESCC to achieve the best prognosis and avoid missing positive lymph nodes (PLNs).

Methods: A total of 497 patients with pT1 to pT2 esophageal cancer from two institutions were retrospectively analyzed and their surgical and pathological records were critically reviewed. Stepwise analyses were conducted by calculating a serial of hazard ratios and odd ratios to determine the optimal range of lymphadenectomy for overall survival (OS).

Results: The best survival outcome can be obtained when the number of lymph node examined (NLNE) is 10-18 in pT1N0 ESCC, while the NLNE should exceed 24 in pT2N0 diseases. In patients with pT1-2Nany and pT2Nany ESCC, resection of 15-25 and 24-37 lymph nodes, respectively, could provide significant added value for identifying positive nodal metastasis. When the NLNE exceeds this appropriate range, resection of extra lymph node is not helpful to improve the probability of finding PLNs.

Conclusions: For ESCC patients undergoing radical esophagectomy, the optimal extent of lymphadenectomy is 15-25 for pT1Nany disease and 24-37 for pT2Nany disease.

Keywords: esophageal squamous cell carcinoma (ESCC); lymphadenectomy; negative lymph node; prognosis; surgical strategy.