Surgery Today

, Volume 49, Issue 5, pp 378–386 | Cite as

Preoperative lymph node status on computed tomography influences the survival of pT1b, T2 and T3 esophageal squamous cell carcinoma

  • Kotaro SugawaraEmail author
  • Hiroharu Yamashita
  • Yukari Uemura
  • Koichi Yagi
  • Masato Nishida
  • Susumu Aikou
  • Sachiyo Nomura
  • Yasuyuki Seto
Original Article



The preoperative lymph node status is critical for tailoring optimal treatments for esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the prognostic impact of a diagnostic criterion based solely on the short-axis diameters of lymph nodes depicted on computed tomography (CT) in ESCC patients undergoing upfront esophagectomy.


We retrospectively reviewed 246 pT1b–T3 ESCC patients undergoing upfront esophagectomy. Clinically positive lymph node metastasis (cN+) was defined as nodes with a short-axis diameter of at least 8 mm on CT.


Ninety-three patients had a cN+ status according to this criterion. The overall and recurrence-free survival rates were significantly lower in the cN+ group than in the cN− group (P < 0.001). The overall survival rate was markedly lower in the “pN2/3 and cN+” group than in the other groups (vs. pN0: P < 0.001, vs. pN1: P = 0.002, vs. “pN2/3 and cN−”: P < 0.001). However, the overall survival rate of the “pN2/3 and cN−” group was similar to that of the pN0–1 groups. A multivariate analysis showed that cN+ (P = 0.002), major complications (P = 0.001), and pT3 (P = 0.021) were independently associated with a poor prognosis.


A diagnostic criterion based solely on the short-axis diameters of lymph nodes depicted on CT was useful for stratifying the survival in ESCC patients.


Esophageal squamous cell carcinoma Preoperative lymph node status Computed tomography 



Esophageal squamous cell carcinoma


Computed tomography


Neoadjuvant chemoradiotherapy


Lymph node


Video-assisted thoracoscopic surgery




Neoadjuvant chemotherapy


18F-fluorodeoxyglucose positron tomography


Endoscopic ultrasonography


Hazard ratios


Confidence interval




Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.


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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Gastrointestinal Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Bariatric and Metabolic Care, Graduate School of MedicineThe University of TokyoTokyoJapan
  3. 3.Biostatistics Division, Clinical Research Support Center, Graduate School of MedicineThe University of TokyoTokyoJapan

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