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Impact of Thoracic Recurrent Laryngeal Node Dissection: 508 Patients with Tri-Incisional Esophagectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

To evaluate the feasibility and safety of recurrent laryngeal nerve (RLN) lymph node (LN) dissection, this study compared the postoperative complications and survival between modern two-field lymphadenectomy (MTL) and modified standard two-field lymphadenectomy (MSTL) by using the propensity score matching method.

Methods

After generating propensity scores given the covariates of age, sex, tumor length, tumor location, tumor grade, and clinical stage, 254 patients with MTL were matched to 254 MSTL patients using the nearest available score matching. The LNs resected during MSTL were paraesophageal and preparatracheal LNs in the upper mediastinum, in addition to those resected during standard two-field lymphadenectomy.

Results

RLN LNs were those most commonly affected by nodal metastasis in our series (26 %). Metastasis in RLN LNs was found in around 35, 25, and 20 % of patients with cancer in the upper, middle, and lower thoracic esophagus, respectively. LN metastasis was confined to the RLN region in 49 patients. Even 35 % of patients with pT1 tumors had positive RLN LNs. MTL increased the mean number of resected LNs when compared to MSTL (29 vs.15; p < 0.001). Recurrence was more frequent in those assigned MSTL than those assigned MTL (p < 0.001). The 5-year overall survival (OS) and disease-free survival (DFS) rate for MTL were 50.7 and 42 % compared to 35.3 and 28.2 % for MSTL (both p < 0.001), respectively. Postoperative complications were more frequent following MTL when compared to the MSTL. However, no statistically significant difference in postoperative complications was observed between the two groups.

Conclusions

Adding the removal of RLN LNs might improve OS and DFS with acceptable morbidity for patients with ESCC.

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Acknowledgments

This work was supported by “5010 plan” from Sun Yat-sen University (grant 2007044), which focuses on randomized control studies with multidisciplinary therapy on esophageal carcinoma. We thank the members of the Department of Thoracic Surgery, Radiology, Epidemiology and Pathology at the Sun Yat-sen University Cancer Center for cooperation and assistance.

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Authors and Affiliations

  1. Gastrointestinal Institute of Sun Yat-sen University, Department of Thoracic Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China

    Zihui Tan & Jinming Zhao

  2. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China

    Guowei Ma, Amos Ela Bella, Tiehua Rong, Jianhua Fu, Yuqi Meng, Kongjia Luo, Dongrong Situ & Peng Lin

  3. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China

    Guowei Ma, Amos Ela Bella, Tiehua Rong, Jianhua Fu, Yuqi Meng, Kongjia Luo, Dongrong Situ & Peng Lin

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  1. Zihui Tan
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  2. Guowei Ma
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  10. Peng Lin
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Correspondence to Peng Lin.

Additional information

Zihui Tan and Guowei Ma contributed equally to this work.

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Tan, Z., Ma, G., Zhao, J. et al. Impact of Thoracic Recurrent Laryngeal Node Dissection: 508 Patients with Tri-Incisional Esophagectomy. J Gastrointest Surg 18, 187–193 (2014). https://doi.org/10.1007/s11605-013-2411-2

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  • DOI: https://doi.org/10.1007/s11605-013-2411-2

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