Abstract
Objective
The aim of this study was to determine the significance of lymphadenectomy for recurrence after treatment for esophageal squamous cell carcinoma.
Methods
Short- and long-term outcomes of 24 patients who underwent lymphadenectomy for recurrence in 3 hospitals between April 2004 and March 2013 were retrospectively analyzed. There were 17 cases with lymph node recurrence after esophagectomy (11 cervical, 4 mediastinal, and 2 abdominal node recurrences) and 7 cases with remnant or recurrent lymphatic diseases after definitive chemoradiotherapy (3 cervical, 1 mediastinal, and 3 abdominal node recurrences).
Results
Three minor complications were observed among 24 patients and the median postoperative hospital stay was 7 days. The 3-year progression-free and overall survivals of patients who underwent secondary lymphadenectomy for recurrence after esophagectomy were 51.5 and 75.5 %, respectively. The overall survival of patients with cervical node recurrence was significantly better than that of patients with mediastinal or abdominal node recurrence in this group (P = 0.0097). The median progression-free and overall survivals of patients who underwent salvage lymphadenectomy after definitive chemoradiotherapy were 2 and 15 months, respectively. Although only 1 patient experienced local recurrence after secondary lymphadenectomy, locoregional failures occurred in 6 of 7 patients who underwent salvage lymphadenectomy after definitive chemoradiotherapy.
Conclusion
Secondary or salvage lymphadenectomy can be performed safely in the selected patients. Secondary lymphadenectomy achieves locoregional disease control and results in a favorable long-term outcome, particularly for cervical node recurrence. Further large-scale cohort studies are needed to determine the prognostic significance of salvage lymphadenectomy after definitive chemoradiotherapy.
Similar content being viewed by others
References
Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg. 1994;220:364–73.
Cai WJ, Xin PL. Pattern of relapse in surgical treated patients with thoracic esophageal squamous cell carcinoma and its possible impact on target delineation for postoperative radiotherapy. Radiother Oncol. 2010;96:104–7.
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. 2010;5:707–12.
Watanabe M, Nishida K, Kimura Y, Kiyazaki M, Baba H. Salvage lymphadenectomy for cervical lymph node recurrence after esophagectomy for squamous cell carcinoma of the thoracic esophagus. Dis Esophagus. 2012;25:62–6.
Shitara K, Muro K. Chemoradiotherapy for treatment of esophageal cancer in Japan: current status and perspectives. Gastrointest Cancer Res. 2009;3:66–72.
Kato H, Sato A, Fukuda H, Kagami Y, Udagawa H, Togo A, et al. A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group Study (JCOG9708). Jpn J Clin Oncol. 2009;39:638–43.
Kato K, Muro K, Minashi K, Ohtsu A, Ishikura S, et al. Phase II study of chemoradiotherapy with 5-fluorouracil and cisplatin for stage II-III esophageal squamous cell carcinoma: JCOG trial (JCOG 9906). Int J Radiat Oncol Biol Phys. 2011;81:684–90.
Ohtsu A, Boku N, Muro K, Chin K, Muto M, Yoshida S, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol. 1999;17:2915–21.
Toh Y, Oki E, Minami K, Okamura T. Follow-up and recurrence after a curative esophagectomy for patients with esophageal cancer: the first indicators for recurrence and their prognostic value. Esophagus. 2010;7:37–43.
Kato H, Fukuchi M, Miyazaki T, Nakajima M, Kimura H, Faried A, et al. Classification of recurrent esophageal cancer after radical esophagectomy with two- or three-field lymphadenectomy. Anticancer Res. 2005;25:3461–7.
Smit JK, Pultrum BB, van Dullemen HM, van Dam GM, Groen H, Plukker JT. Prognostic factors and patterns of recurrence in esophageal cancer assert arguments for extended two-field transthoracic esophagectomy. Am J Surg. 2010;200:446–53.
Nakamura T, Ota M, Narumiya K, Sato T, Ohki T, Yamamoto M, et al. Multimodal treatment for lymph node recurrence of esophageal carcinoma after curative resection. Ann Surg Oncol. 2008;15:2451–7.
Yano M, Doki Y, Miyashiro I, Kishi K, Noura S, Eguchi H, et al. Prognosis of patients who develop cervical lymph node recurrence following curative resection for thoracic esophageal cancer. Dis Esophagus. 2006;19:73–7.
Swisher SG, Wynn P, Putnam LB, Mosheim MB, Correa AM, Komaki RR, et al. Salvage esophagectomy for recurrent tumors after definitive chemoradiotherapy and radiotherapy. J Thorac Cardiovasc Surg. 2002;123:175–83.
Tachimori Y. Role of salvage esophagectomy after definitive chemoradiotherapy. Gen Thorac Cardiovasc Surg. 2009;57:71–8.
Miyata H, Yamasaki M, Takiguchi S, Nakajima K, Fujiwara Y, Nishida T, et al. Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer. J Surg Oncol. 2009;100:442–6.
Sakai M, Suzuki S, Sano A, Tanaka N, Inose T, Sohda M, et al. Significance of lymph node capsular invasion in esophageal squamous cell carcinoma. Ann Surg Oncol. 2012;19:1911–7.
Tallinger CMR, Ruderer M, Hejna M. Esophageal cancer: a critical evaluation of systemic second-line therapy. J Clin Oncol. 2011;29:4709–17.
Conflict of interest
The authors have nothing to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Watanabe, M., Mine, S., Yamada, K. et al. Outcomes of lymphadenectomy for lymph node recurrence after esophagectomy or definitive chemoradiotherapy for squamous cell carcinoma of the esophagus. Gen Thorac Cardiovasc Surg 62, 685–692 (2014). https://doi.org/10.1007/s11748-014-0444-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-014-0444-4