| Background and objective:Esophageal cancer has a high incidence and mortality rate worldwide.China accounts for over 50% of the world’s cases of oesophageal cancer.Oesophageal cancer in East Asia is dominated by squamous-cell carcinoma.Survival depends on the intraoperative removal of lymph nodes.Surgical treatment of resectable esophageal cancer remains.The value of the mode of lymph node metastasis(LNM)and the intensity of dissection in overall survival(OS)of ESCC remains controversial.In this study,we sought to accurately stage the tumor and elucidate the relationship between the tumor and the lymph node dissection.Objective: To investigate the effect of lymph node dissection times on OS in patients with squamous cell carcinoma of the oesophagus.Methods : The Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database(SCH-ECCM)was collected Database)from January 2010 to August 2017,a total of 2957 patients with esophageal squamous cell carcinoma underwent surgery,excluding patients with less than 15 lymph nodes dissected.Clinical data including basic status,surgical plan,lymph node dissection at each station during operation,and postoperative adjuvant therapy were collected.Participants were divided into two groups: node-negative(N0)and node-positive(N+)patients.The median number of lymph nodes removed during operation(RLNs)was 24.Therefore,patients with 15-23 and >23 RLNs were assigned to groups A and B,respectively.Results : The EI was elevated in the supraclavicular and mediastinal areas in patients with upper oesophageal tumours,and 101R’s EI was 17.39,which was highest among the lymph node sites.In terms of the rate of lymph node metastasis(LNM),the superior mediastinum was 52.57%,which included the 106 rec R(39.55%),106 rec L(28.95%),105(24.42%),and 106 tb L(20%)stations.The EI was elevated in the mediastinal area followed by the celiac and supraclavicular areas in patients with mid-esophageal tumors,104 R with an EI of 12.88 was the highest among lymph node stations,rates of LNM in the upper mediastinum were the highest,34.32%,and the LNM rates in the supraclavicular,middle mediastinum,and perigastric were similar,all around 30%.In patients with lower esophageal tumors,EI was elevated in the celiac area followed by the mediastinal areas,the EI of the left gastric artery was 11.33,the rates of LNM in the perigastric area were significantly higher than those in the other lymph node area,50.39%,followed by the supraclavicular(25%),middle mediastinum(23.58%),inferior mediastinum(23.42%),superior mediastinum(21.55%),and celiac(21.13%).The median OS was 52.03 and 29.2 months for the N+ group.The N0 group failed to reach median OS.The median OS for Groups A and B in the N+ group was27.5 months and 33.0 months,respectively.The OS at 1,3,and 5 years were 79%,39%,and 30%,respectively,in N+ Group A;and 82%,47% and 35% in N+ Group B,respectively.N0 Groups A and B showed no statistically significant difference.Conclusion : Increasing the number of lymph nodes obtained intraoperatively to >23 improved OS in node-positive patients but not in node-negative patients.The EI of the simultaneously resected lymph nodes varied between different locations and was related to the primary location of the tumor. |
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