Impact of splenic node dissection on short-term outcome and survival following esophagectomy

Clinical value of station 4R node dissection in esophageal squamous cell carcinoma

BACKGROUND

Many controversies still exist concerning the optimal extent of lymphadenectomy during esophagectomy in esophageal squamous cell carcinoma (ESCC). The objective of this study was to explore the characteristics of 4R metastasis and evaluate the clinical value of 4R node dissection in ESCC.

METHODS

A total of 736 ESCC patients who underwent radical esophagectomy between 2005 and 2013 were retrospectively collected, among which 393 ones underwent 4R dissection. Propensity score matching (PSM) method was applied to reduce the effects of confounding variables between the 4R dissection and non-dissection groups to analyze overall survival.

RESULTS

Patients showed a low 4R metastasis rate of 5.1% (20/393) (5.2%, 5.8%, and 1.8% for upper, middle, and lower tumors, respectively). Correlation analyses identified that 4R metastasis was significantly associated with station 2R metastasis (p < 0.001) and pathologic tumor-node-metastasis (pTNM) stage (p < 0.001). All 4R metastases were observed in stages IIIB and IVA. Moreover, patients with station 4R dissection failed to achieve significantly improved overall survival compared with those without 4R dissection, regardless of tumor stage (overall: p = 0.696; stage 0-IIIA: p = 0.317; stage IIIB-IVA: p = 0.619).

CONCLUSION

4R metastasis is likely to be associated with more aggressive disease, and routine 4R node dissection might not be necessary for ESCC patients.

A cost-effectiveness modeling study of treatment interventions for stage I to III esophageal squamous cell carcinoma

Background

Esophageal cancer causes considerable costs for health systems. Appropriate treatment options for patients with esophageal squamous cell carcinoma (ESCC) can reduce medical costs and provide more improved outcomes for health systems and patients. This study evaluates the cost-effectiveness of treatment interventions for patients with ESCC according to the Iranian health system.

Material and methods

A five-state Markov model with a 15-year time horizon was performed to evaluate the cost-effectiveness of treatment interventions based on stage for ESCC patients. Costs ($US 2021) and outcomes were calculated from the Iranian health system, with a discount rate of 3%. One-way sensitivity analyses were performed to assess the potential effects of uncertain variables on the model results.

Results

In stage I, the Endoscopic Mucosal Resection (EMR) treatment yielded the lowest total costs and highest total QALY for a total of $1473 per QALY, making it the dominant strategy compared with esophagectomy and EMR followed by ablation. In stages II and III, chemoradiotherapy (CRT) followed by surgery dominated esophagectomy. CRT followed by surgery was also cost-effective with an incremental cost-effectiveness ratio (ICER) of $2172.8 per QALY compared to CRT.

Conclusion

From the Iranian health system’s perspective, EMR was the dominant strategy versus esophagectomy and EMR followed by ablation for ESCC patients in stage I. The CRT followed by surgery was a cost-effective intervention compared to CRT and esophagectomy in stages II and III.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12962-022-00352-5.

Is Routine Subcarinal Lymph Node Dissection Necessary in Superficial Esophageal Squamous Cell Carcinoma? A Propensity Score Matching Analysis

Background: The purpose of this study was to investigate the impact of subcarinal lymph node dissection on short-term and long-term outcomes after esophagectomy in patients with superficial esophageal squamous cell carcinoma (ESCC).

Methods: From January 2010 to December 2015, 490 patients with pT1 ESCC were enrolled in the study. Patients in subcarinal dissection or non-dissection group were matched randomly in a 2:1 ratio, eventually, 255 patients were selected for further statistical analysis.

Results: The metastasis rate of subcarinal lymph nodes in superficial ESCC was 1.24% and significantly lower than the other stations (7.14-9.96%). Compared with dissection group, non- dissection group had shorter operation time (193±35 vs. 204±39, P=0.016), less blood loss (157±48 vs. 178±29, P=0.011) as well as lower incidence of pulmonary complications (9.4 vs. 20%, P=0.032). At a median follow-up of 46 months, the recurrent rate in each group was similar (16.5 vs. 15.3%, P=0.809). Survival analysis revealed no overall survival (P=0.992) and disease-free survival (P=0.665) reductions in non-dissection group. In univariate and multivariate analyses, subcarinal lymph node dissection was not a predictive factor of overall and disease-free survival in superficial ESCC.

Conclusion: Subcarinal lymph node dissection was not beneficial and could be omitted in superficial ESCC.