Thoracic: Esophageal Cancer
Clinical significance of left tracheobronchial lymph node dissection in thoracic esophageal squamous cell carcinoma

https://doi.org/10.1016/j.jtcvs.2022.02.050Get rights and content

Abstract

Objective

The left tracheobronchial lymph nodes are considered as regional lymph nodes for esophageal squamous cell carcinoma, but routine prophylactic left tracheobronchial lymph node dissection for all resectable esophageal squamous cell carcinoma has been controversial. This study aimed to evaluate the prognostic impact of left tracheobronchial lymph node dissection and left tracheobronchial lymph node metastases in thoracic esophageal squamous cell carcinoma and to analyze the risk factors of left tracheobronchial lymph node metastases.

Methods

A total of 3522 patients with esophageal squamous cell carcinoma undergoing esophagectomy were included. Overall survival was calculated by a Kaplan–Meier method and compared using the log-rank test. Propensity score matching was conducted to adjust confounding factors. Univariable and multivariable logistic regression analyses were used to identify independent risk factors of left tracheobronchial lymph node metastases.

Results

In this study, 608 patients underwent left tracheobronchial lymph node dissection and 45 patients had left tracheobronchial lymph node metastases (7.4%). After propensity score matching, the 5-year overall survival in patients receiving left tracheobronchial lymph node dissection was better than in patients who did not (68.2% vs 64.6%, P = .012). In patients receiving left tracheobronchial lymph node dissection, patients with left tracheobronchial lymph node metastases had a significantly poorer survival than patients without (5-year overall survival: 40.5% vs 62.2%, P = .029). Multivariable logistic analyses showed that clinical T stage and tumor differentiation were independent risk factors for left tracheobronchial lymph node metastases.

Conclusions

In thoracic esophageal squamous cell carcinoma, station left tracheobronchial lymph node metastases indicate a poor prognosis and left tracheobronchial lymph nodes dissection seems to be associated with a more favorable prognosis. Clinical T stage and tumor differentiation were independent risk factors for left tracheobronchial lymph node metastases. For patients with high risk, routine prophylactic left tracheobronchial lymph node dissection should be performed.

Section snippets

Patients

From January 2010 to December 2018, 4240 patients with EC who underwent radical esophagectomy combined with lymphadenectomy were collected from the retrospective institutional database. This study was approved by the Institutional Review Board of our hospital, and the informed consents were waived. Candidates were screened according to inclusion criteria: (1) age between 18 and 85 years; (2) diagnosis of thoracic ESCC; (3) no history of previous or concomitant malignancy; and (4) complete

Patient Characteristics

In the whole cohort, 608 patients (17.3%) underwent station 4L LN dissection, as shown in Table 1. To assess the balance of covariates, the SDs were calculated. The analysis showed that covariates were unbalanced in tumor length, tumor location, tumor differentiation, surgical technique, neoadjuvant therapy, adjuvant therapy, clinical T stage, and N stage between patients with and without station 4L LN dissection (SD > 0.10). After PSM, balance in baseline characteristics was achieved

Discussion

The 4L LNs are considered as regional LNs for thoracic EC, but routine prophylactic 4L lymphadenectomy has been controversial.9, 10, 11 Because of the complex anatomy of station 4L, most thoracic surgeons did not remove 4L LNs in esophagectomy, resulting in the lack of a large sample of clinical data about 4L LN dissection and station 4L LNM, and their impacts on prognosis. Therefore, we carried out this study to evaluate the effect of 4L LN dissection and station 4L LNM on the prognosis in

Conclusions

In this study, station 4L LNM was associated with a poorer prognosis of patients with thoracic ESCC, but station 4L LN dissection seems to be associated with a more favorable prognosis. Multivariable analysis showed that clinical T stage and tumor differentiation were independent risk factors for station 4L LNM. For patients with high risk, routine prophylactic 4L LN dissection should be recommended (Figure 4).

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    • This study was funded by the Special Program for Basic Resource Survey of the Ministry of Science and Technology (2019FY101101).

    Institutional Review Board Approval Number: 20/388-2584; November 18, 2020.

    Accepted for the 2021 International Thoracic Surgical Oncology Summit: The Best of In-Person and Virtual Education.

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    © 2022 by The American Association for Thoracic Surgery