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Li Z, Gai C, Zhang Y, Wen S, Lv H, Xu Y, Huang C, Zhao B, Tian Z. Comparisons of minimally invasive esophagectomy and open esophagectomy in lymph node metastasis/dissection for thoracic esophageal cancer. Chin Med J (Engl) 2022; 135:2446-2452. [PMID: 36507705 PMCID: PMC9944355 DOI: 10.1097/cm9.0000000000002342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The study aimed to clarify the characteristics of lymph node metastasis (LNM) and to compare the oncologic outcomes of minimally invasive esophagectomy (MIE) with open esophagectomy (OE) in terms of lymph node dissection (LND) in thoracic esophageal cancer patients. METHODS The data from esophageal cancer patients who underwent MIE or OE from January 2016 to January 2019 were retrospectively reviewed. The characteristics of LNM in thoracic esophageal cancer were discussed, and the differences in numbers of LND, LND rate, and LNM rate/degree of upper mediastinum between MIE and OE were compared. RESULTS For overall characteristics of LNM in 249 included patients, the highest rate of LNM was found in upper mediastinum, while LNM rate in middle and lower mediastinum, and abdomen increased with the tumor site moving down. The patients were divided into MIE ( n = 204) and OE groups ( n = 45). In terms of number of LND, there were significant differences in upper mediastinum between MIE and OE groups (8 [5, 11] vs. 5 [3, 8], P < 0.001). The comparative analysis of regional lymph node showed there was no significant difference except the subgroup of upper mediastinal 2L and 4L group (3 [1, 5] vs. 0 [0, 2], P < 0.001 and 0 [0, 2] vs. 0, P = 0.012, respectively). Meanwhile, there was no significant difference in terms of LND rate except 2L (89.7% [183/204] vs. 71.1% [32/45], P = 0.001) and 4L (41.2% [84/204] vs . 22.2% [10/45], P = 0.018) groups. For LNM rate of T3 stage, there was no significant difference between MIE and OE groups, and the comparative analysis of regional lymph node showed that there was no significant difference except 2L group (11.1% [5/45] vs . 38.1% [8/21], P = 0.025). The LNM degree of OE group was significantly higher than that of MIE group (27.2% [47/173] vs . 7.6% [32/419], P < 0.001), and the comparative analysis of regional LNM degree showed that there was no significant difference except 2L (34.7% [17/49] vs . 7.7% [13/169], P < 0.001) and 4L (23.8% [5/21] vs . 3.9% [2/51], P = 0.031) subgroups. CONCLUSION MIE may have an advantage in LND of upper mediastinum 2L and 4L groups, while it was similar to OE in other stations of LND.
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Affiliation(s)
- Zhenhua Li
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Chunyue Gai
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Yuefeng Zhang
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Shiwang Wen
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Huilai Lv
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Yanzhao Xu
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Chao Huang
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Bo Zhao
- Department of Medical Iconography, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Ziqiang Tian
- Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
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Yu Y, Wang W, Li Q, Zhao F, Zhou Y, Xu J, Huang C. Prognostic value of lymph node count on survival in pathologically node-negative oesophageal squamous cell cancer. Interact Cardiovasc Thorac Surg 2017; 26:407-412. [PMID: 29177502 DOI: 10.1093/icvts/ivx363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 10/13/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yue Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Li
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Pathology, National Cancer Center/Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Zhou
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chenjun Huang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Zhang J, Heng X, Luo Y, Fu Q, Li Z, Che F, Li B. Influence of negative lymph node in No 7 on survival of patients with middle thoracic esophageal squamous cell carcinoma. Onco Targets Ther 2016; 9:1831-7. [PMID: 27099516 PMCID: PMC4821374 DOI: 10.2147/ott.s94236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The overall survival (OS) of patients with thoracic esophageal cancer is poor because of the high rate of lymph node metastases. However, recent studies found that the negative lymph node (LN) may also influence the patients’ OS. The purpose of this study is to investigate which negative LN stations play a key role in OS prediction. Method Our study included the retrospective records of 99 patients, who were identified with middle thoracic esophageal squamous cell cancer after esophagectomy. The maximum follow-up time was 6 years. Cox regression models were employed to determine the association between the negative LN and OS of patients. After applying Kaplan–Meier method to calculate OS of patients with positive and negative LNs, the log-rank tests were used to assess the difference between them. Result The hazard ratio of the total number of negative LNs was 0.937 (P=0.001), and the length of tumor was 1.166 (P=0.038). Multivariate regression results showed that the numbers of positive LNs in No 3 and 7 stations and negative LNs in No 109 and 7 stations were significantly related to OS, and their P-values were 0.017, 0.001, 0.020, and 0.022, respectively. The OS of the patients who had positive and negative LNs in No 7 station was significantly different (P=0.028). Conclusion No 7 is the most important among the negative LN stations which prolong OS. More attention should be paid to this area when making treatment plan for patients with no negative LNs identified in operation.
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Affiliation(s)
- Jinling Zhang
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Xueyuan Heng
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Yi Luo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Qingxi Fu
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Zhengrong Li
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Fengyuan Che
- Cancer Center, LinYi People Hospital, Affiliated to Shandong University, School of Medicine, Jinan, Shandong Province, People's Republic of China
| | - Baosheng Li
- Department of Radiation Oncology (Chest Section), Shandong's Key Laboratory of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
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Xu XL, Zheng WH, Zhu SM, Zhao A, Mao WM. The Prognostic Impact of Lymph Node Involvement in Large Scale Operable Node-Positive Esophageal Squamous Cell Carcinoma Patients: A 10-Year Experience. PLoS One 2015; 10:e0133076. [PMID: 26177369 PMCID: PMC4503716 DOI: 10.1371/journal.pone.0133076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/22/2015] [Indexed: 02/07/2023] Open
Abstract
Background Lymph node (LN)-related factors including the number of LN regions involved, the LN ratio (LNR), and the number of metastatic LNs are strong prognostic indicators for esophageal squamous cell carcinoma (ESCC) patients. Accurately staging LN involvement may improve the stratification of patients and guide the management of patients. Methods A total of 688 potentially resectable patients who had regional LN metastases were enrolled in this retrospective study. Results ESCC involving a single region was associated with better outcomes than that involving multiple regions (P < 0.001 for both PFS and OS). An increased number of metastatic LNs was significantly associated with reduced PFS and OS based on univariate analysis (P < 0.001). PFS and OS were significantly higher in patients with a lower cancer-involved LNR, with 5-year OS rates of 9.7% and 31.4% for patients with a lower and higher cancer-involved LNR, respectively. Based on multivariate analysis, patients with N1 LN involvement experienced longer survival than patients with N2 LN involvement (HR: 1.37; 95% CI: 1.12-1.68) or N3 LN involvement (HR: 1.96; 95% CI: 1.52-2.53). Higher LNR resulted in longer OS than lower LNR based on multivariate analysis (HR: 1.45; 95% CI: 1.15-1.84; P = 0.002). Conclusions Our study has shown that not only the number of metastatic LNs but also the number of involved LN regions predicts outcomes after definitive surgery among Chinese patients with N-positive ESCC. LNR might serve as a powerful indicator that should be included in TNM staging for EC patients.
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Affiliation(s)
- Xiao-Ling Xu
- Department of Medical Oncology, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou City, China
- Key Laboratory on Diagnosis and Treatment Technology on Thoracic Cancer, Zhejiang Cancer Hospital (Zhejiang Cancer Research Institute), Hangzhou, Zhejiang Province, China
| | - Wei-Hui Zheng
- Key Laboratory on Diagnosis and Treatment Technology on Thoracic Cancer, Zhejiang Cancer Hospital (Zhejiang Cancer Research Institute), Hangzhou, Zhejiang Province, China
| | - Shuang-Mei Zhu
- Department of Radio-Chemotherapy Oncology, Lishui People’s Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - An Zhao
- Key Laboratory on Diagnosis and Treatment Technology on Thoracic Cancer, Zhejiang Cancer Hospital (Zhejiang Cancer Research Institute), Hangzhou, Zhejiang Province, China
| | - Wei-Min Mao
- Key Laboratory on Diagnosis and Treatment Technology on Thoracic Cancer, Zhejiang Cancer Hospital (Zhejiang Cancer Research Institute), Hangzhou, Zhejiang Province, China
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China
- * E-mail:
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Yang L, Duan DK, Jin Z, Li W, Zhang GR, Wang JG. Influence of classic vs modified Ivor-Lewis procedure on lung function and postoperative complications in patients with middle-lower thoracic esophageal carcinoma. Shijie Huaren Xiaohua Zazhi 2014; 22:5675-5679. [DOI: 10.11569/wcjd.v22.i36.5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the influence of classic vs modified Ivor-Lewis procedure on lung function and postoperative complications in patients with middle-lower thoracic esophageal carcinoma.
METHODS: Clinical data for 67 patients with middle-lower thoracic esophageal cancer undergoing classic Ivor-Lewis esophagectomy and 66 patients with middle-lower thoracic esophageal cancer undergoing modified Ivor-Lewis esophagectomy from January 2010 to December 2013 were collected. The operativetime, number of resected lymphnodesand postoperativepathology were compared between the two groups. The lung function, including respiratory rate, vital capacity (VC), forced expiratory volume in one second (FEV1) and maximal ventilatory volume (MVV), was investigated 1 wk and 1 d preoperatively and 2 wk postoperatively. Postoperative complications were recorded.
RESULTS: The operativetime did not differ significantly between the classicgroup and modifiedgroup (204.7 min ± 42.1min vs192.5 min ±38.7min, P > 0.05). No statistically significant difference was found in the total number of resected lymph nodes between the two groups, although a higher number of mediastinal lymph nodes were dissected in the classicgroup (8.02 ± 1.65 vs 3.73 ± 0.89, P < 0.05). The postoperative lymph node metastasis rate was significantly higher in the classicgroup (23.88% vs 12.12%, P < 0.05). The respiratory rate, VC and FEV1 of the classicgroup were superior to those of the modified group (P < 0.05). Similar incidence rates of postoperative chylothorax, recurrent laryngeal nerve injuryand anastomotic leakage were observed between groups, but there was a significantly lower rate of postoperative pulmonary complications in the classicgroup than in the modifiedgroup (2.99% vs 12.12%, P < 0.05).
CONCLUSION: Classic Ivor-Lewis procedure has more satisfying clinical effects in terms of mediastinal lymph node dissection, decreased lung injury and postoperative complications.
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Ma X, Li B, Yang S, Guo W, Zhu X, Li H, Xiang J, Zhang Y, Chen H. Extent of lymph node dissection: common hepatic artery lymph node dissection can be omitted for esophageal squamous cell carcinoma. J Thorac Dis 2014; 6 Suppl 3:S325-32. [PMID: 24876938 PMCID: PMC4037418 DOI: 10.3978/j.issn.2072-1439.2014.04.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/21/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Controversy persists regarding the adequate extent of lymph node (LN) dissection in thoracic esophageal cancer (EC) surgery. Oncologic efficacy should be balanced with the increased risk of postoperative complications after aggressive radical LN dissection. Here, we evaluate the effectiveness of common hepatic artery LN dissection in surgery for thoracic esophageal squamous cell carcinoma. PATIENTS AND METHODS Among a total of 1,563 EC patients who underwent surgery from May 2005 to December 2012 at the Fudan University Shanghai Cancer Center, 1,248 thoracic esophageal squamous cell carcinoma were selected for this study, including 682 patients who underwent esophagectomy with common hepatic artery LN dissection and 566 patients who underwent esophagectomy without common hepatic artery LN dissection. The clinical data of patients were retrospectively analyzed. In addition, the locoregional LN metastasis, relationship between metastatic rates of common hepatic artery LN and clinicopathological factors were analyzed. A propensity score match analysis were performed to control for potential differences in the characteristics of patients with EC cell carcinoma, and postoperative complications were analyzed after propensity score-matching. RESULTS The metastatic rate of common hepatic LN was 3.5%. Logistic regression analysis revealed tumor diameter, N classification and pTNM stage were risk factors for common hepatic LN metastasis. Matching based on propensity scores produced 361 patients in each group. The overall incidence of postoperative complications was 32.70% and 35.45%, respectively, no significant difference was found (P=0.432). CONCLUSIONS The metastatic rate of common hepatic artery LN is low. For patients who undergo resection for Stage I thoracic esophageal squamous cell carcinoma, the dissection of common hepatic artery LN may be safely omitted.
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Shim YM, Park JS, Lee M, Kim D, Kim K. Can common hepatic artery lymph node dissection be safely omitted in surgery for clinical T1N0 thoracic esophageal squamous cell carcinoma? Dis Esophagus 2013; 26:272-5. [PMID: 22642487 DOI: 10.1111/j.1442-2050.2012.01361.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Common hepatic artery lymph node dissection is regarded as a standard procedure in esophageal cancer surgery because of aggressive lymphatic dissemination of esophageal cancer. However, lymph node dissection can prolong operation time and may be associated with complications such as chylous ascites. Here, we aimed to evaluate the effectiveness of common hepatic artery lymph node dissection in clinical T1N0 thoracic esophageal squamous cell carcinoma. Between 1996 and 2009, 1390 patients underwent surgery for esophageal cancer in our institution, and 209 were found to have clinical T1N0 disease. Exclusion criteria were nonsquamous carcinoma, double primary cancer, definite distant metastasis, administration of neoadjuvant treatment, and incomplete abdominal lymph node dissection. We retrospectively analyzed medical records, operative and pathologic data, and follow-up information. Forty-two patients were excluded from the study. Among the 167 enrolled patients, preoperative endoscopic ultrasound evaluation was performed in 160 patients. Fifty-two patients had distal esophageal or esophagogastric junction tumor. Surgery included 2 cases of tri-incisional esophagectomy, 17 cases of transhiatal esophagectomy, and 148 cases of two-field esophagectomy (Ivor Lewis operation). Common hepatic artery lymph node dissection was performed in all cases, and none of the patients had metastasis. Mean follow-up period was 35.4 ± 28.7 months. In-hospital mortality was one, and 5-year survival rate was 80.6%. Among the 15 patients with recurrence, there were two distant metastases and five distant and local recurrences but no intra-abdominal recurrence with common hepatic artery lymph node. Common hepatic artery lymph node dissection may be safely omitted in surgery for clinical T1N0 esophageal squamous cell carcinoma when preoperative evaluations including chest computed tomography, positron emission tomography and computed tomography, and esophagogastroduodenoscopy or endoscopic ultrasound are performed.
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Affiliation(s)
- Y M Shim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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