Article

World Journal of Surgery

, Volume 30, Issue 8, pp 1441-1449

First online:

Impact of the Number and Extent of Positive Lymph Nodes in 200 Patients with Thoracic Esophageal Squamous Cell Carcinoma after Three-field Lymph Node Dissection

  • Hideaki ShimadaAffiliated withDepartment of Frontier Surgery, Chiba University Graduate School of MedicineDepartment of Academic Surgery, Chiba University Graduate School of Medicine Email author 
  • , Shin-ichi OkazumiAffiliated withDepartment of Frontier Surgery, Chiba University Graduate School of Medicine
  • , Hisahiro MatsubaraAffiliated withDepartment of Frontier Surgery, Chiba University Graduate School of Medicine
  • , Yoshihiro NabeyaAffiliated withDepartment of Frontier Surgery, Chiba University Graduate School of Medicine
  • , Tooru ShiratoriAffiliated withDepartment of Frontier Surgery, Chiba University Graduate School of Medicine
  • , Takanori ShimizuAffiliated withDepartment of Frontier Surgery, Chiba University Graduate School of Medicine
  • , Kiyohiko ShutoAffiliated withDepartment of Frontier Surgery, Chiba University Graduate School of Medicine
  • , Hideki HayashiAffiliated withDepartment of Frontier Surgery, Chiba University Graduate School of Medicine
  • , Takenori OchiaiAffiliated withDepartment of Frontier Surgery, Chiba University Graduate School of Medicine

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Abstract

Background

Subtotal esophagectomy with three-field lymph node dissection (3FLD) has been reported to improve survival in patients with thoracic esophageal squamous cell carcinoma (SCC). The purpose of this study was to evaluate the prognostic impact of the extent and number of positive lymph nodes for long-term survival of patients who underwent 3FLD.

Methods

From January 1983 to December 2002, a total of 200 patients with thoracic esophageal SCC underwent 3FLD without any neoadjuvant therapy. The prognostic impact of the extent and number of positive lymph nodes was evaluated by both univariate and multivariate analysis.

Results

The extent of positive nodes associated with a 5-year survival were as follows: none, 69%; one-field, 50%; two-field, 29%; and three-field, 11%. The number of positive nodes associated with 5-year survival were as follows: single node, 65%; two-nodes, 51%; and more than three-nodes, 20%. Among patients with cervical lymphatic spreading, patients with upper tumors showed significantly better survival than patients with lower tumors (P = 0.036). Multivariate analysis indicated that number of positive nodes and the abdominal node status were independent prognostic factors among lymph node status.

Conclusions

Together, number and extent of positive lymph nodes can be considered an independent predictor of a high risk of recurrence. Although cervical lymphatic spreading was risk factor for worse survival, patients with upper tumors may have survival benefit after cervical lymph node dissection.