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01-02-2016 | Thoracic Oncology

The Prognostic Relevance of Subcarinal Lymph Node Dissection in Esophageal Squamous Cell Carcinoma

Authors: Yukiko Niwa, MD, PhD, Masahiko Koike, MD, PhD, Masashi Hattori, MD, Naoki Iwata, MD, PhD, Hideki Takami, MD, PhD, Masamichi Hayashi, MD, PhD, Chie Tanaka, MD, PhD, Daisuke Kobayashi, MD, PhD, Mitsuro Kanda, MD, PhD, Suguru Yamada, MD, PhD, FACS, Tsutomu Fujii, MD, PhD, FACS, Goro Nakayama, MD, PhD, Hiroyuki Sugimoto, MD, PhD, Michitaka Fujiwara, MD, PhD, Yasuhiro Kodera, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 2/2016

Abstract

Background

The objective of this study was to evaluate the prognostic relevance of subcarinal lymph node dissection in patients with esophageal squamous cell carcinoma (ESCC) and to identify a subset of patients in whom subcarinal lymph node dissection can be omitted.

Methods

We retrospectively analyzed 342 consecutive patients with thoracic ESCC who underwent R0 subtotal esophagectomy. All patients underwent subcarinal lymph node dissection. The efficacy index (frequency of metastasis to a particular lymph node station multiplied by the 5-year disease-specific survival rate of patients with metastasis to the station) was calculated for the subcarinal lymph node station, and the prognostic impact of dissecting this station was estimated with reference to the main tumor location. Independent predictive factors for pathological subcarinal lymph node metastasis were analyzed using a proportional hazards model.

Results

The overall frequency of metastasis to the subcarinal lymph nodes was 7.0 % (2.4, 8.9, and 5.8 % in patients with upper, middle, and lower thoracic ESCC, respectively). The efficacy index for the middle thoracic esophagus was 2.9, and that for the upper and lower thoracic esophagus was 0.0. The 5-year disease-free survival rate was significantly lower in patients with pathological subcarinal lymph node metastasis than those without (23.1 vs. 67.5 %, respectively; log-rank p < 0.0001). In multivariate analysis, clinical T stage (T2–T4) was the independent predictive factor for pathological subcarinal lymph node metastasis (p = 0.021).

Conclusions

Subcarinal lymph node dissection might have little value in patients with upper and lower thoracic ESCC and could be omitted, especially for superficial carcinoma.

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Title: The Prognostic Relevance of Subcarinal Lymph Node Dissection in Esophageal Squamous Cell Carcinoma
Authors: Yukiko Niwa, MD, PhD
Masahiko Koike, MD, PhD
Masashi Hattori, MD
Naoki Iwata, MD, PhD
Hideki Takami, MD, PhD
Masamichi Hayashi, MD, PhD
Chie Tanaka, MD, PhD
Daisuke Kobayashi, MD, PhD
Mitsuro Kanda, MD, PhD
Suguru Yamada, MD, PhD, FACS
Tsutomu Fujii, MD, PhD, FACS
Goro Nakayama, MD, PhD
Hiroyuki Sugimoto, MD, PhD
Michitaka Fujiwara, MD, PhD
Yasuhiro Kodera, MD, PhD, FACS
Publication date: 01-02-2016
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 2/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4819-2

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Springer Medicine

The Prognostic Relevance of Subcarinal Lymph Node Dissection in Esophageal Squamous Cell Carcinoma

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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