Skip to main content

Advertisement

SpringerLink
Log in

Significance of dissection in each regional lymph-node station of esophageal cancer based on efficacy index and recurrence patterns after curative esophagectomy

  • Original Article
  • Published:
Esophagus Aims and scope Submit manuscript

Abstract

Background

The optimal extent of lymph-node (LN) dissection in esophageal cancer has not been established. Although the frequency and patterns of recurrence in each regional LN station after radical dissection are important in determining the regional LNs of thoracic esophageal cancer to be routinely dissected, this information has not been investigated sufficiently. We studied the significance of dissection at each LN station based on their recurrence patterns.

Methods

Six hundred and twelve patients with esophageal cancer who underwent curative esophagectomy were studied. The incidence and pattern of recurrence (systemic or non-systemic) at each regional LN station were analyzed. To compare the significance of dissection among regional LNs, the efficacy index (EI) was also calculated.

Results

Regional LN recurrence was diagnosed in 101 (16.5%) patients. Among the regional LNs, recurrent laryngeal nerve, paraesophageal, and perigastric LNs showed higher EIs (3.1–6.7). Pretracheal and posterior thoracic para-aortic LNs showed low EIs (0–0.2). Supraclavicular LNs had moderate EIs (1.7–2.0). The recurrence rate was highest in the pretracheal LN, followed by the supraclavicular LNs. The majority (81.8%) of the pretracheal LN had a systemic recurrence, while about half (right: 60.0%, left: 43.8%) of the supraclavicular LNs had a systemic recurrence.

Conclusion

Due to the high incidence of systemic recurrence or low EI for pretracheal and posterior thoracic para-aortic LNs, we suggest that these LN stations be regarded as non-regional LNs and be excluded from routine dissection. Supraclavicular LNs may also be excluded from routinely dissected stations.

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. Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008;248:549–56.

    Article  PubMed  Google Scholar 

  2. Visser E, Markar SR, Ruurda JP, et al. Prognostic value of lymph node yield on overall survival in esophageal cancer patients: a systematic review and meta-analysis. Ann Surg. 2019;269:261–8.

    Article  PubMed  Google Scholar 

  3. Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Annals of Cardiothoracic Surg. 2017;6:119–30.

    Article  Google Scholar 

  4. Japan ES. Japanese classification of esophageal cancer, 11th Edition: part I. Esophagus. 2017;14:1–36.

    Article  Google Scholar 

  5. Hagens ERC, van Berge Henegouwen MI, van Sandick JW, et al. Distribution of lymph node metastases in esophageal carcinoma [TIGER study]: study protocol of a multinational observational study. BMC Cancer. 2019;19:662.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tachimori Y, Ozawa S, Numasaki H, et al. Efficacy of lymph node dissection by node zones according to tumor location for esophageal squamous cell carcinoma. Esophagus. 2016;13:1–7.

    Article  PubMed  Google Scholar 

  7. Udagawa H, Ueno M, Shinohara H, et al. The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol. 2012;106:742–7.

    Article  PubMed  Google Scholar 

  8. Miyata H, Sugimura K, Yamasaki M, et al. Clinical impact of the location of lymph node metastases after neoadjuvant chemotherapy for middle and lower thoracic esophageal cancer. Ann Surg Oncol. 2019;26:200–8.

    Article  PubMed  Google Scholar 

  9. Depypere L, Lerut T, Moons J, et al. Isolated local recurrence or solitary solid organ metastasis after esophagectomy for cancer is not the end of the road. Dis Esophagus. 2017;30:1–8.

    CAS  PubMed  Google Scholar 

  10. Kosuga T, Shiozaki A, Fujiwara H, et al. Treatment outcome and prognosis of patients with lymph node recurrence of thoracic esophageal squamous cell carcinoma after curative resection. World J Surg. 2011;35:798–804.

    Article  PubMed  Google Scholar 

  11. Makino T, Yamasaki M, Miyata H, et al. Solitary lymph node recurrence of esophageal squamous cell carcinoma: surgical failure or systemic disease? Ann Surg Oncol. 2016;23:2087–93.

    Article  PubMed  Google Scholar 

  12. Yano M, Takachi K, Doki Y, et al. Prognosis of patients who develop cervical lymph node recurrence following curative resection for thoracic esophageal cancer. Dis Esophagus. 2006;19:73–7.

    Article  CAS  PubMed  Google Scholar 

  13. Miyata H, Tanaka K, Makino T, et al. The Impact of pathological tumor regression and nodal status on survival and systemic disease in patients undergoing neoadjuvant chemotherapy for esophageal squamous cell carcinoma. Ann Surg Oncol. 2018;25:2409–17.

    Article  PubMed  Google Scholar 

  14. Parry K, Visser E, van Rossum PS, et al. Prognosis and treatment after diagnosis of recurrent esophageal carcinoma following esophagectomy with curative intent. Ann Surg Oncol. 2015;22(Suppl 3):S1292–300.

    Article  PubMed  Google Scholar 

  15. Yamamoto M, Yamasaki M, Tanaka K, et al. New classification for the thoracic paraaortic lymph nodes of patients with esophageal squamous cell carcinoma. Surg Today. 2018;48:217–22.

    Article  PubMed  Google Scholar 

  16. Hatooka S, Abe T, Saito T, et al. Lymph node metastasis of an esophageal cancer behind the thoracic descending aorta. Esophagus. 2010;7:111–4.

    Article  Google Scholar 

  17. Saito H, Sato T, Miyazaki M. Extramural lymphatic drainage from the thoracic esophagus based on minute cadaveric dissections: fundamentals for the sentinel node navigation surgery for the thoracic esophageal cancers. Surg Radiol Anat. 2007;29:531–42.

    Article  PubMed  Google Scholar 

  18. Wang Y, Zhu L, Xia W, et al. Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer. Cancer Manag Res. 2018;10:6295–303.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shishido Y, Miyata H, Sugimura K, et al. Successful resection after neoadjuvant chemotherapy for esophageal cancer with posterior thoracic paraaortic lymph node metastasis: a case report and literature review. Gen Thorac Cardiovasc Surg. 2017;65:542–8.

    Article  PubMed  Google Scholar 

  20. Hsu CP, Hsu NY, Shai SE, et al. Pre-tracheal lymph node metastasis in squamous cell carcinoma of the thoracic esophagus. Eur J Surg Oncol. 2005;31:749–54.

    Article  CAS  PubMed  Google Scholar 

  21. Igaki H, Tachimori Y, Kato H. Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg. 2004;239:483–90.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shimada H, Okazumi S, Matsubara H, et al. 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. World J Surg. 2006;30:1441–9.

    Article  PubMed  Google Scholar 

  23. Tachimori Y, Ozawa S, Numasaki H, et al. Supraclavicular node metastasis from thoracic esophageal carcinoma: a surgical series from a Japanese multi-institutional nationwide registry of esophageal cancer. J Thorac Cardiovasc Surg. 2014;148:1224–9.

    Article  PubMed  Google Scholar 

  24. 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. 2019;26:2899–904.

    Article  PubMed  Google Scholar 

  25. 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 

  26. 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.

    Article  PubMed  Google Scholar 

  27. Cui T, Zhang H, Yu T, et al. Pattern of recurrence in 428 patients with thoracic esophageal squamous cell carcinoma after radical surgery and its implication in postoperative radiotherapeutic clinical target volume. Front Oncol. 2021;11:652365.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Liu Q, Cai XW, Wu B, et al. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma: implications for the clinical target volume design of postoperative radiotherapy. PLoS ONE. 2014;9:e97225.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wu SG, Dai MM, He ZY, et al. Patterns of regional lymph node recurrence after radical surgery for thoracic esophageal squamous cell carcinoma. Ann Thorac Surg. 2016;101:551–7.

    Article  PubMed  Google Scholar 

  30. Ni W, Yang J, Deng W, et al. Patterns of recurrence after surgery and efficacy of salvage therapy after recurrence in patients with thoracic esophageal squamous cell carcinoma. BMC Cancer. 2020;20:144.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 541-8567, Japan

    Takashi Kanemura, Hiroshi Miyata, Tomohira Takeoka, Takahito Sugase & Keijiro Sugimura

  2. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan

    Kotaro Yamashita, Koji Tanaka, Tomoki Makino & Yuichiro Doki

  3. Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, 3-1-1, Notame, Minami-ku, Fukuoka, Japan

    Mitsuhiko Ota & Yasushi Toh

  4. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Koichi Yagi & Yasuyuki Seto

Authors
  1. Takashi Kanemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomohira Takeoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takahito Sugase
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Keijiro Sugimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kotaro Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koji Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomoki Makino
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mitsuhiko Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Koichi Yagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yasushi Toh
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yasuyuki Seto
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yuichiro Doki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroshi Miyata.

Ethics declarations

Ethical statement

All procedures followed were in accordance with the ethical standards of all participating hospitals and with the Helsinki Declaration of 1964 and later versions.

Conflict of interest

There are no conflicts of interest to disclose.

Additional information

Publisher's Note

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

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kanemura, T., Miyata, H., Takeoka, T. et al. Significance of dissection in each regional lymph-node station of esophageal cancer based on efficacy index and recurrence patterns after curative esophagectomy. Esophagus 20, 402–409 (2023). https://doi.org/10.1007/s10388-022-00977-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10388-022-00977-8

Keywords

Search

Navigation