Regularity Of Celiac Lymph Node Recurrence After The Complete Resection Of Thoracic Esophageal Carcinoma: Implications For Postoperative Radiation Therapy Volumes

objective:To analyze the celiac lymph node recurrence regularity and region after surgical resection of thoracic esophageal carcinoma, and discuss the target design of postoperative radiation therapy. Methods:Between Feb 2005 and Mar 2013,1536 patients after R0 resection of thoracic esophageal carcinoma were enrolled,analyze had celiac lymph node recurrence patients, with most of them be determined by enhanced CT, some by MRI or PET-CT, We then retrospectively analyzed the pattern of the celiac lymph node recurrence after R0 resection, which was divided according to the gastric lymph node grouping guidelines developed by Japanese Gastric Cancer Association. Results:Celiac lymph node recurrence may happen in any parts of the thoracic esophageal carcinoma.but lower thoracic esophageal carcinoma metastasis rate is higher than middle and lower thoracic esophageal carcinoma,a significant difference among the three groups (x2=143.88, P<0.0001); the celiac lymph node recurrence rate of node-positive group is higher than lymph node-negative, and have a significant difference (x2=39.523, P<0.0001); but there is no difference between T1/2 group and T3/4 group in celiac lymph node recurrence rate (x2= 1.294, P=0.255);the celiac lymph node recurrence rate of more than 3 node-positive group is higher than lymph node-negative group and less than 3 node-positive group, and have a significant difference (x2=93.046, P< 0.0001); there is no difference between adjuvant therapy group and without adjuvant therapy group in celiac lymph node recurrence rate (x2= 0.498, P=0.480); Among the 148 patients with celiac lymph node recurrence,there were 6, 87 and 55 patients presented with upper, middle and lower thoracic esophageal carcinoma, respectively. Of the whole cohort,58 patients(39.2%) developed had celiac lymph node metastasis as the first failure site after operation, among them,35 patients (23.6%)concomitantly presented with other regional lymph node metastasis Twenty-nine patients(19.6%) had distant site metastasis,26 patients(19.6%) had both distant metastasis and regional lymph node metastasis at other sites. The incidence of celiac lymph node metastasis in different subgroup were 79.7% for periaortic (group 16),37.8% for celiac axis (group 9), 32.4% for behind pancreatic head(group 13),20.9% for next to hepatic artery (group 8)、9.5% for former head of the pancreas(group 17)、8.1% for subphrenic(group 9)、6.8% for the superior mesenteric artery and vein lymph node(group 14), with the incident rate of other subgroups all less than 5%. Among those with group 16 lymph node metastasis, the incidence of 16a1,16a2,16b1 and 16b2 were 41.2%,64.9%,6.8% and 0.7%, respectively. The total incident rate of group 8,9,13,16al and 16a2 was 91.9%, while there were only 8.1% of them would developed celiac lymph node in other regions. Conclusions:The mainly regions of abdominal lymph node metastasis after R0 resection in thoracic esophageal squamous carcinoma were group 16a1,61a2,9,13 and 8.We suggested that these regions should be delineated into target volume in postoperative radiotherapy. For those with lower thoracic esophageal carcinoma who presented with more than 3 lymph nodes metastasis, preventive radiotherapy should be performed in those regions just mentioned above.