Background: China is a high incidence area of esophageal cancer. Esophageal squamous cell carcinoma recurrence and mortality rates are relatively high. Recent studies show that the recurrence rate remains very high even through the implementation of lymph node expanding dissection. Methods and Results: In order to study the relationship between lymph node dissection number and survival of the patients with esophageal squamous cell carcinoma, 407 cases of esophageal cancer are selected in the First Affiliated Hospital of Xi’an Jiaotong University from January 2009 to June 2013. There were 15 cases without surgery, while the rest of the 392 patients were post-operation in follow-up. 54 patients were lost in follow-up, and the rate was 13.8%. Finally, there were 338 patients entered into our research. The median age was 58 (37 - 81), males accounted for 79%. The number of lymph node dissection is for a total of 2091, and a median of 5. Positive lymph nodes are 400, while the total positive rate is 19.1%. Conclusion: The number of lymph node dissection is divided into 3 groups that are 0 to 6, 7 to 11, 12 or more into three grades, and reduced number of lymph node dissection may prolong the survival (P < 0.05). The number of lymph node dissection should be as less as possible unless there is definitely positive lymph node metastasis.
References
[1]
Chen, W.Q., Zheng, R.S., Baade, P.D., Zhang, S.W., Zeng, H.M., He, J., et al. (2016) Cancer Statistics in China, 2015. CA: A Cancer Journal for Clinicians.
[2]
Gockel, I., Sgourakis, G., Lyros, O., Polotzek, U., Schimanski, C.C., Lang, H., et al. (2011) Risk of Lymph Node Metastasis in Submucosal Esophageal Cancer: A Review of Surgically Resected Patients. Expert Review of Gastroenterology & Hepatology, 5, 371-384. http://dx.doi.org/10.1586/egh.11.33
[3]
Bollschweiler, E., Baldus, S.E., Schröder, W., Prenzel, K., Gutschow, C., Schneider, P.M., et al. (2006) High Rate of Lymph-Node Metastasis in Submucosal Esophageal Squamous-Cell Carcinomas and Adenocarcinomas. Endoscopy, 38, 149-156. http://dx.doi.org/10.1055/s-2006-924993
[4]
Baba, M., Aikou, T., Yoshinaka, H., Natsugoe, S., Fukumoto, T., Shimazu, H., et al. (1994) Long-Term Results of Subtotal Esophagectomy with Three-Field Lymphadenectomy for Carcinoma of the Thoracic Esophagus. Annals of Surgery, 219, 310. http://dx.doi.org/10.1097/00000658-199403000-00012
[5]
Sharma, S., Fujita, H., Yamana, H. and Kakegawa, T. (1994) Patterns of Lymph Node Metastasis in 3-Field Dissection for Carcinoma in the Thoracic Esophagus. Surgery Today, 24, 410-414. http://dx.doi.org/10.1007/BF01427033
[6]
Ando, N., Ozawa, S., Kitagawa, Y., Shinozawa, Y. and Kitajima, M. (2000) Improvement in the Results of Surgical Treatment of Advanced Squamous Esophageal Carcinoma during 15 Consecutive Years. Annals of Surgery, 232, 225. http://dx.doi.org/10.1097/00000658-200008000-00013
[7]
Shen, Y., Zhang, Y., Tan, L., Feng, M., Wang, H., Khan, M.A., Liang, M., et al. (2012) Extensive Mediastinal Lymphadenectomy during Minimally Invasive Esophagectomy: Optimal Results from a Single Center. Journal of Gastrointestinal Surgery, 16, 715-721. http://dx.doi.org/10.1007/s11605-012-1824-7
[8]
Groth, S.S., Virnig, B.A., Whitson, B.A., De For, T.E., Li, Z.Z., Tuttle, T.M., et al. (2010) Determination of the Minimum Number of Lymph Nodes to Examine to Maximize Survival in Patients with Esophageal Carcinoma: Data from the Surveillance Epidemiology and End Results Database. The Journal of Thoracic and Cardiovascular Surgery, 139, 612-620. http://dx.doi.org/10.1016/j.jtcvs.2009.07.017
[9]
Rizk, N.P., Ishwaran, H., Rice, T.W., Chen, L.Q., Schipper, P.H., Kesler, K.A., et al. (2010) Optimum Lymphadenectomy for Esophageal Cancer. Annals of Surgery, 251, 46-50. http://dx.doi.org/10.1097/SLA.0b013e3181b2f6ee
[10]
Bottger, T., Terzic, A. and Muller, M. (2006) Extent of Lymphnode Dissection with Minimally Invasive Esophageal Resection. Zentralblatt fur Chirurgie, 131, 466-473.
[11]
Sjoquist, K.M., Burmeister, B.H. and Smithers, B.M. (2011) Survival after Neoadjuvant Chemotherapy or Chemoradiotherapy for Resectableoesophageal Carcinoma: An Updated Meta-Analysis. The Lancet Oncology, 12, 681-692. http://dx.doi.org/10.1016/S1470-2045(11)70142-5
[12]
Oezcelik, A., Kaiser, G.M., Niebel, W., Sleyman, C., Treckmann, J.W., Sotiropoulos, G.C., et al. (2012) Ten-Year Survival of Esophageal Cancer after an En-Bloc Esophagectomy. Journal of Surgical Oncology, 105, 284-287. http://dx.doi.org/10.1002/jso.22096
[13]
Mandard, A.M., Chasle, J., Marnay, J., Villedieu, B., Bianco, C., Roussel, A., et al. (1981) Autopsy Findings in 111 Cases of Esophageal Cancer. Cancer, 48, 329-335. http://dx.doi.org/10.1002/1097-0142(19810715)48:2<329::AID-CNCR2820480219>3.0.CO;2-V
[14]
Natsugoe, S., Nakashima, S., Nakajo, A., Matsumoto, M., Okumura, H., Tokuda, K., et al. (2003) Bone Marrow Micrometastasis Detected by RT-PCR in Esophageal Squamous Cell Carcinoma. Oncology Reports, 10, 1879-1883.
[15]
Nakamura, T., Matsunami, K., Hayashi, K., Ota, M., Ide, H. and Takasaki, K. (2004) Detection of Bone Marrow Micrometastasis in Esophageal Cancer Patients by Immunomagnetic Separation. Oncology Reports, 11, 999-1003.
[16]
Vashist, Y.K., Effenberger, K.E., Vettorazzi, E., Riethdorf, S., Yekebas, E.F., Izbicki, J.R., et al. (2012) Disseminated Tumor Cells in Bone Marrow and the Natural Course of Resected Esophageal Cancer. Annals of Surgery, 255, 1105-1112. http://dx.doi.org/10.1097/SLA.0b013e3182565b0b
[17]
Nishihira, M.D., Hirayama, M.D. and Mori, M.D. (1998) A prospective Randomized Trial of Extended Cervical and Superior Mediastinal Lymphadenectomy for Carcinoma of the Thoracic Esophagus. The American Journal of Surgery, 175, 47-51. http://dx.doi.org/10.1016/S0002-9610(97)00227-4
[18]
Tabira, Y., Okuma, T., Kondo, K. and Kitamura, N. (1999) Indications for Three-Field Dissection Followed by Esophagectomy for Advanced Carcinoma of the Thoracic Esophagus. The Journal of Thoracic and Cardiovascular Surgery, 117, 239-245. http://dx.doi.org/10.1016/S0022-5223(99)70418-6
[19]
Igaki, H., Tachimori, Y. and Kato, H. (2004) Improved Survival for Patients with Upper and/or Middle Mediastinal Lymph Node Metastasis of Squamous Cell Carcinoma of the Lower Thoracic Esophagus Treated with 3-Field Dissection. Annals of Surgery, 239, 483. http://dx.doi.org/10.1097/01.sla.0000118562.97742.29
[20]
Miyata, H., Yamasaki, M., Makino, T., Miyazaki, Y., Takahashi, T., Kurokawa, Y., et al. (2015) Therapeutic Value of Lymph Node Dissection for Esophageal Squamous Cell Carcinoma after Neoadjuvant Chemotherapy. Journal of Surgical Oncology, 112, 60-65. http://dx.doi.org/10.1002/jso.23965
