Postoperative Recurrence Pattern And Selection Of Postoperative Adjuvant Treatment Options In Patients With Esophageal Squamous Cell Carcinoma Complicated With Para-Recurrent Laryngeal Nerve Lymph Node Metastasis

Objective:To learn the postoperative recurrence pattern and influencing factors in patients with esophageal squamous cell carcinoma(ESCC)complicated with para-recurrent laryngeal nerve lymph node metastasis,thereby providing a basis for the selection of postoperative adjvant treatment.Methods:A retrospective analysis was conducted on 119 patients with postoperative para-recurrent laryngeal nerve lymph node metastasis who underwent thoracoscopic and laparoscopic esophagectomy for esophageal cancer(McKeown procedure)and extended two-field lymph node dissection between January 1,2016,and December 31,2020,in the thoracic surgery of the Affiliated Hospital of North Sichuan Medical College.Investigate the pattern of recurrent,factors influencing recurrence within 1 year were analyzed by logistic regression,while factors influencing postoperative recurrence and recurrence of cervical or supraclavicular lymph nodes were analyzed by the Cox’s proportional hazards regression model.Results:Of a total of 119 patients,54 patients(45.4%;54/119)recurred after operation,among which 29(53.7%;29/54)recurred within 1 year,47(87.0%;47/54)recurred within 2 years,and 51(94.4%;51/54)recurred within 3 years.In addition,there were 42 cases with local recurrence alone(77.8%,42/54),among which we observed 24 cases with cervical or supraclavicular recurrence(57.1%,24/42),18 cases with mediastinal lymph node recurrence(42.9%,18/42),and 5 cases with anastigmatic recurrence(11.9%,5/42).Meanwhile,7 cases exhibited distant metastasis alone(13.0%of the total number of recurrence,7/54).Moreover,5 cases had local recurrence combined with distant metastasis(9.3%of the total number of recurrence,5/54).Of the 29 cases with recurrence within 1 year,21 cases were local recurrence(50.0%of the total number of local recurrence,21/42),5 cases were distant metastasis(71.4%of the total number of distant metastases,5/7),and 3 cases were local recurrence combined with distant metastasis(60.0%of the total number of local recurrence combined with distant metastasis,3/5).Binary logistic regression analysis manifested that the presence and absence of postoperative adjuvant therapy,postoperative pathological tumor node metastasis stage,and the number of lymph nodes dissected intraoperatively were independent influencing factors for the postoperative recurrence of ESCC within 1 year.Cox regression analysis unraveled that postoperative adjuvant chemotherapy,radiotherapy,or chemoradiotherapy[compared with operation alone,chemotherapy had P=0.014,hazard ratios(HR)=0.351,and HR 95%confidence interval(95%CI)=0.152 to 0.811 and radiotherapy or chemoradiotherapy had P=0.005,HR=0.116,and HR 95%CI=0.026 to 0.517]was an independent prognostic factor affecting recurrence of cervical or supraclavicular lymph nodes in patients with para-recurrent laryngeal nerve lymph node metastasis after operation for ESCC.Furthermore,this analysis elaborated tumor lymph node stage N2(compared with stage N1,stage N2 had P=0.005,HR=2.268,and HR 95%CI=1.081 to 2.442),postoperative adjuvant radiotherapy or chemoradiotherapy(compared with operation alone,radiotherapy or chemoradiotherapy had P=0.022,HR=0.406,and HR 95%CI=0.188 to 0.878),and the number of lymph nodes dissected intraoperatively(P=0.043;HR=0.544;HR 95%CI=0.302 to 0.981)as the independent prognostic factors for para-recurrent laryngeal nerve lymph node metastasis following thoracoscopic and laparoscopic esophagectomy for esophageal cancer.Conclusion:From the results,we draw three conclusions.Firstly,the recurrence rates of postoperative cervical or supraclavicular lymph nodes were high in patients with ESCC complicated with para-recurrent laryngeal nerve lymph node metastasis.Secondly,postoperative radiotherapy or chemoradiotherapy,the number of lymph nodes dissected intraoperatively,and the N2 stage of lymph nodes were independent prognostic factors afflicting postoperative recurrence in patients with ESCC complicated with para-recurrent laryngeal nerve lymph node metastasis.Thirdly,adjuvant radiotherapy or chemoradiotherapy was recommended for patients with ESCC complicated with para-recurrent laryngeal nerve lymph node metastasis after operation.