Characteristics Of Common Hepatic Artery Lymph Node Metastasis From Thoracic Esophageal Squamous Cell Carcinoma And The Rational Strategies Of Extensive Dissection

Objective: To study and analyze characteristics of common hepatic artery lymph node metastasis from thoracic esophageal squamous cell carcinoma,and to investigate the rational strategies of common hepatic artery lymph node dissection.Methods: The clinical data of 187 patients with esophageal squamous eell carcinoma who were admitted to the department of thoracic surgery in Fujian Medical University Union Hospital from May 2012 to May 2015 were retrospectively analyzed.The locoregional lymph node metastasis of thoracic esophageal squamous cell carcinoma,relationship between metastatic rates of common hepatic artery lymph node and clinicopathological factors and the postoperative complications were analyzed.The enumeration data were analyzed using the chi-square test.Results: A total of 4935 lymph nodes were dissected(26 lymph nodes per patient).The lymph node metastatic rate was 63.10%(118/187),and the metastatic lymph node ratio was 7.66%(378/4935).Lymph nodes adjacent to the cardia of stomach,celiac artery,supraclavicular,splenic artery, had a higher metastatic rate,while cornmon hepatic artery lymph node had a lower metastatic rate.Two patients had common hepatic artery lymph node metastasis was not accompanied with locoregional metastasis.A total of 485 common hepatic artery lymph nodes were dissected(3 common hepatic artery lymph nodes per patient).Sixteen patients had common hepatic artery lymph node metastasis,with the metastatic rate of 8.56%(16/187)and the lymph node ratio of 5.36%(26/485).Logistic regression analysis identified that N classification and p TNM stage were risk factors for common hepatic LN metastasis.The sex,age,tumor location,tumor length,tumor invasion degree,tumor pathological type,tumor differentiation have no significant difference with the common hepatic artery lymph node metastatic.Fifty-five patients had postoperative complications with the complication rate of 29.41%(55/187).The incidence of pulmonary complication was the highest,which was 16.58%(31/187).Conclusions:The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is the lowest.Common hepatic artery LN may be safely omitted in esophagectomy for thoracic esophageal squamous cell carcinoma at stage I. The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is 8.56%,and on the side of the N staging of N2 and N3 stage esophageal carcinoma patients with hepatic artery lymph node metastasis rate was significantly higher than that of N1, so for pathologic TNM staging evaluation for N staging for N2 and above of esophageal squamous cell carcinoma patients need regular hepatic lymph node dissection.