Clinical Investigation Of Two-field Lymphadenectomy For Squamous Cell Carcinoma Of The Lower Thoracic Esophagus

ObjectiveTo analyze the clinical outcome of two-field lymphadenectomy for the patients with squamous cell carcinoma of the lower thoracic esophagus and to explore the appropriate surgical management for the regional lymph node.MethodsFrom January2004to December2007,300patients with squamous cell carcinoma of the lower thoracic esophagus underwent Ivor-Lewis subtotal esophagectomy with two-field lymph node lymphadenectomy. The clinicopathological information, the lymph node metastatic pattern, postoperative complication and prognosis were analyzed retrospectively between the two different managements of lymph node dissection. Follow-up data were obtained by telephone or letter. The follow-up time ranged3-89month (median36month). All300patients have complete follow-up data, no perioperative death case, the patients died of other causes were processed as censored data. Results143patients underwent standard two-field lymphadenectomy (upper abdominal+middle and lower mediastinal lymph node dissection) and157patients underwent totally two-field lymphadenectomy (upper abdominal+middle and lower mediastinal+upper mediastinal lymph node dissection). Among these patients lymph node metastasis is most common in the upper abdomen, followed by the lower mediastinum, and the frequencies of nodal metastases in the upper mediastinum is21%, but isolated lymph node involvement observed in the upper mediastinum only account for0.6%. The difference in clinicopathological characteristics of two groups was not statistically significant. The total number of dissected lymph nodes with totally two-field lymphadenectomy are more than that with standard two-field lymphadenectomy (30.1±9.8vs.26.3±8.5); the incidence of postoperative hoarseness for the patient underwent totally two-field lymphadenectomy is higher (16.6%), and so to the incidence of respiration failure. To the two postoperative complication, compared to the patient underwent standard two-field lymphadenectomy, the difference was statistically significant (5.1%vs.0.7%, χ2=4.970, P=0.038).5years survival rate had no significant difference between two group (28.9%vs.30.2%, x2=0.006, P=0.936). T stage (HR=1.799, P=0.000) and N stage (HR=1.639, P=0.000) of the tumor was respectively the independent risk factors no matter how to perform the lymphadenectomy.5years survival rate for the patients with negative upper mediastinal lymph node was significantly higher than that patients with positive upper mediastinal lymph node (34.8%vs.8.5%, χ2=17.982, P=0.000). Independent risk factors for upper mediastinal lymph node metastasis are T stage (OR=4.591,P=0.032)and upper abdominal lymph node metastasis (OR=3.648,P=0.014). Conclusionl.For the patients with lower thoracic esophageal squamous cell carcinoma the metastasis lymph nodes are mainly found in abdominal region and middle and lower mediastinal region. Usually upper mediastinal lymph node metastasis is secondary;2.There are more the lymph nodes dissected for the patient underwent totally two field lymphadenectomy, that help to accurate staging;3.The pattern of totally two field lymphadenectomy for the patient with lower thoracic esophageal squamous cell carcinoma cannot improve the survival rate, on the contrary, there is a significant increase in postoperative complications;4. The patients underwent two field lymphadenectomy with locally advanced lower thoracic esophageal squamous cell carcinoma have poor prognosis and the further studies are needed to the effect of selective three field lymphadenectomy or adjuvant treatment;...