A Meta-analysis Of The Effect Of The Two-field And The Three-field Lymphadenectomy On The Prognosis Of Patients With Esophageal Cancer

Objective :To compare the effect of two different types of two-field lymphadenectomy and three-field lymphadenectomy on the survival and prognosis of patients with esophageal cancer so as to find out which lymph node dissection is the best technique to improve the prognosis of patients.Methods: Comparative literature on the influence of two-field and three-field lymphadenectomy on the prognosis of patients with esophageal cancer was searched through Pub Med,the Cochrane Library,CNKI,VIP and Wanfang Database.Rev Man 5.3software was used for data processing and analysis.Results: A total of 9,840 patients were included in the study,of which 5,837 patients in 2-F and 4,003 patients in 3-F.The results of Meta analysis showed that the overall survival rate of three-field lymphadenectomy in patients with esophageal cancer at 1,3and 5 years was significantly better than that of the two-field lymphadenectomy(OR =0.57,95% CI: 0.38-0.85,P = 0.006;0.72,95% CI: 0.65-0.80,P = 0.000;OR = 0.68,95%CI: 0.57-0.81,P = 0.000)and significantly lower in terms of the recurrence rate of cervical lymph nodes(OR = 2.01,95% CI: 1.14-3.52,P = 0.02),the 3-year and 5-year survival rate of patients with middle and upper thoracic esophageal cancer undergoing three-field lymphadenectomy was significantly better than that of two-field lymphadenectomy(OR=0.65,95% CI: 0.49-0.85,P= 0.002;OR = 0.52,95% CI:0.41-0.65,P = 0.000),However,there is no difference was found between the two groups in the lower esophageal cancer patients(P=0.08;P = 0.18).There was no difference between the two groups in the five-year disease-free survival rate(P=0.25).Conclusion:three-field lymphadenectomy can significantly improve the overall survival rate of patients with esophageal cancer at 1 year,3 years and 5 years compared with the two-field lymphadenectomy,especially in the upper and middle esophageal cancer patients,and reduce the recurrence rate of cervical lymph nodes,In the lower esophageal cancer patients there is no significant difference between the two groups.