Skip to main content
SpringerLink
Log in

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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jemal A, Murray T, Samuels A, et al. Cancer statistics, 2003. CA Cancer J Clin. 2003;53:5–26.

    Article  PubMed  Google Scholar 

  2. Wu PC, Posner MC. The role of surgery in the management of esophageal cancer. Lancet Oncol. 2003;4:481–8.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  5. Dresner SM, Griffin SM. Pattern of recurrence following radical esophagectomy with two-field lymphadenectomy. Br J Surg. 2000;87:1426–33.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  7. Law S, Kwont DLM, et al. Two-field dissection is enough for esophageal cancer. Dis Esophagus. 2001;14:98–103.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Osugi H, Narumiya K, Kudou K. Supracarinal dissection of the oesophagus and lymphadenectomy by MIE. J Thorac Dis. 2017;9:741–50.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  14. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effect. Biometrika. 1983;70:41–55.

    Article  Google Scholar 

  15. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. Oxford: Blackwell; 2010.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan

    Yasufumi Koterazawa MD, Taro Oshikiri MD, Gosuke Takiguchi MD, Hiroshi Hasegawa MD, Masashi Yamamoto MD, Shingo Kanaji MD, Kimihiro Yamashita MD, Tetsu Nakamura MD & Yoshihiro Kakeji MD

  2. Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Takeru Matsuda MD

  3. Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Japan

    Yasuhiro Fujino MD & Masahiro Tominaga MD

  4. Division of Community Medicine and Medical Network, Department of Social Community Medicine and Health Science, Kobe University Graduate School of Medicine, Kobe, Japan

    Satoshi Suzuki MD

Authors
  1. Yasufumi Koterazawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taro Oshikiri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gosuke Takiguchi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Hasegawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masashi Yamamoto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shingo Kanaji MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kimihiro Yamashita MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takeru Matsuda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tetsu Nakamura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yasuhiro Fujino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masahiro Tominaga MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Satoshi Suzuki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yoshihiro Kakeji MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasufumi Koterazawa MD.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koterazawa, Y., Oshikiri, T., Takiguchi, G. et al. Prophylactic Cervical Lymph Node Dissection in Thoracoscopic Esophagectomy for Esophageal Cancer Increases Postoperative Complications and Does Not Improve Survival. Ann Surg Oncol 26, 2899–2904 (2019). https://doi.org/10.1245/s10434-019-07499-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-019-07499-1

Search

Navigation