Effect Of Two Way Lymph Node Dissection On The Prognosis Of Patients With Esophageal Carcinoma:a Meta-analysis

Objective:To explore the effects of 2-field lymphadenectomy(2-FL) and 3-field lymphadenectomy(3-FL) on the prognosis of patients with thoracic esophageal squamous carcinoma by Meta analysis method,Looking for a more reasonable lymph node dissection procedure.Methods:We searched of the PubMed^ Embase, OVID、CBM、CNKI、WanFang databases、VIP database, The retrieval time for a library to the 2014-07.We collected the literatures of effects of 2-FL and 3-FL on the prognosis of patients with thoracic esophageal squamous carcinoma,then according to include and exclude standard screening of literature and assess quality of them. We extracted data from into the literatures and used RevMan5.1 software for data analysis.Results:Two RCTs and 17 retrospective studies with 8444 patients were included.4910 and 3534 cases for 2-FL and 3-FL respectively.The analysis of data showed that There was a clear benefit for 3-FL in the 5-year overall survival rates(OR=1.43,95%CI:1.30-1.57,P<0.05).For Lymph node metastasis rate,the 3-FL was higher than 2-FL,the difference was statistically significant (OR=1.34,95% CI:1.11-1.63,P<0.05).The long-term cervical lymph nodes metastasis rate of 3-FL is lower than 2-FL, the difference was statistically significant (OR=0.44,95% CI:0.22-0.88, P <0.05). For another,3-FL was more than 2-FL in terms of number of lymph node dissection,the difference was statistically significant (MD=25.22,95% CI:16.37-34.07,P< 0.05).For the main postoperative complications, the incidence rate of anastomosis leak (OR=1.68,95CI:1.22-2.31,P<0.05), recurrent nerve palsy (OR= 4.54,95% CI:3.11-6.64, P<0.05)、pulmonary complications (OR=1.65,95% CI:1.15-2.35,P< 0.05).In the secondary outcome,there was no significant difference for chylothorax (OR=1.68,95% CI:1.22-2.31,P< 0.05)、pyothorax (OR=0.97,95%CI:0.50-1.90,P>0.05)、anastomotic stricture (OR=1.36,95%CI:0.73-2.53,P>0.05)、arrhythmia (OR=0.72,95%CI:0.18-2.86, P>0.05). Conclusion:The Meta-analysis shows that there was a clear benefit for 3-FL in the 5-year overall survival rates,but has a higher risk for anastomosis leak、recurrent nerve palsy、pulmonary complications.For another,3-FL has a higher rate of lymph node metastasis in the postoperative patients,it is crucial for the pTNM stage. Along with the medical level of progress,the 3-FL may get further development.