Effectiveness of lymphadenectomy of 1 061 patients based on the grouping of esophageal cancer lymph nodes by Chinese expert consensus: A retrospective analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TU Dehao , QU Rirong , PING Wei , YANG Guang ,  CAI Yixin ,  FU Xiangning

Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China;

Corresponding author：

CAI Yixin, Email: caiyixin@tjh.tjmu.edu.cn; FU Xiangning, Email: fuxn2006@aliyun.com

Keywords：

Esophageal cancer; esophagectomy; lymphadenectomy; Chinese expert consensus; efficacy index

DOI：

10.7507/1007-4848.202110009

Video：

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Objective To assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus. Methods The medical records of 1 061 patients (886 males and 175 females with a median age of 60 (54, 65) years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed. According to the pathological report, the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer. The metastasis rate of each group of lymph nodes, the 5-year survival rate of metastatic patients and efficacy index (EI) were calculated. Results The upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups. The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups. The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes. According to the metastasis rate, the mediastinal lymph nodes were divided into three regions: an upper mediastinum (C201-204), a middle mediastinum (C205-206), and a lower mediastinum (C207-209). The EIs of lymph nodes of C201-203 and C205-207 groups were higher. For patients with C201-207 groups metastasis, the 5-year survival rates ranged from 13.39% to 21.60%. For patients with positive lymph nodes in each region, tumors at different primary locations had no statistical difference in long-term survival (P>0.05). Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs. Conclusion The effect of lymph node dissection in each area varies with the location of the tumor. No matter where the tumor is, it is necessary to dissect the upper mediastinal lymph nodes, especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves. Group C205 should be classified into the lower mediastinal lymph nodes.

Citation： TU Dehao, QU Rirong, PING Wei, YANG Guang, CAI Yixin, FU Xiangning. Effectiveness of lymphadenectomy of 1 061 patients based on the grouping of esophageal cancer lymph nodes by Chinese expert consensus: A retrospective analysis in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 186-193. doi: 10.7507/1007-4848.202110009 Copy

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2.	Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edition: Part Ⅰ. Esophagus, 2017, 14(1): 1-36.
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6.	Tachimori Y, Ozawa S, Numasaki H, et al. Efficacy of lymph node dissection by node zones according to tumor location for esophageal squamous cell carcinoma. Esophagus, 2016, 13: 1-7.
7.	杨丁, 毛友生. 食管癌手术入路和淋巴结清扫范围的选择. 中华胃肠外科杂志, 2016, 19(9): 1069-1072.
8.	Sasako M, McCulloch P, Kinoshita T, et al. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg, 1995, 82(3): 346-351.
9.	Udagawa H, Ueno M, Shinohara H, et al. The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol, 2012, 106(6): 742-747.
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13.	Rizk NP, Ishwaran H, Rice TW, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg, 2010, 251(1): 46-50.
14.	Zheng YZ, Li XQ, Wang JY, et al. Impact of examined lymph node count for esophageal squamous cell carcinoma in patients who underwent right transthoracic esophagectomy. Ann Surg Oncol, 2021, 28(6): 3025-3033.
15.	Ajani JA, D'Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(7): 855-883.
16.	Tan Z, Ma G, Zhao J, et al. Impact of thoracic recurrent laryngeal node dissection: 508 patients with tri-incisional esophagectomy. J Gastrointest Surg, 2014, 18(1): 187-193.
17.	廖志振, 章文龙. 胸段食管癌喉返神经旁淋巴结清扫的临床应用价值. 江西医药, 2021, 56(8): 1162-1164.
18.	Shang QX, Yang YS, Hu WP, et al. Prognostic significance and role of thoracic lymph node metastasis based on Chinese expert consensus in esophageal cancer. Ann Transl Med, 2019, 7(16): 381.
19.	Wang WP, Ni PZ, Yang YS, et al. The role and prognostic significance of aortopulmonary, anterior mediastinal, and tracheobronchial lymph nodes in esophageal cancer: Update of the eighth-edition TNM staging system (2018). Ann Surg Oncol, 2019, 26(4): 1005-1011.
20.	Chao YK, Hsieh MJ, Liu YH, et al. Lymph node evaluation in robot-assisted versus video-assisted thoracoscopic esophagectomy for esophageal squamous cell carcinoma: A propensity-matched analysis. World J Surg, 2018, 42(2): 590-598.
21.	Motoyama S, Sato Y, Wakita A, et al. Extensive lymph node dissection around the left laryngeal nerve achieved with robot-assisted thoracoscopic esophagectomy. Anticancer Res, 2019, 39(3): 1337-1342.
22.	Tong C, Xu Y, Cao H, et al. Short-term outcomes of robot-assisted versus thoracoscopic-assisted minimally invasive esophagectomy. Ann Thorac Surg, 2021, S0003-4975(21): 01304-7.
23.	徐杨, 申翼. 达芬奇机器人在食管外科中的应用. 医学研究生学报, 2021, 34(1): 1-7.

1. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. Eighth Edition. Switzerland: Springer International Publishing. 2017. 185-202.
2. Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edition: Part Ⅰ. Esophagus, 2017, 14(1): 1-36.
3. 中国抗癌协会食管癌专业委员会. 食管癌根治术胸部淋巴结清扫中国专家共识(2017版). 中华消化外科杂志, 2017, 16(11): 1087-1090.
4. Kunisaki C, Makino H, Kimura J, et al. Impact of lymph-node metastasis site in patients with thoracic esophageal cancer. J Surg Oncol, 2010, 101(1): 36-42.
5. Wu N, Chen Z, Pang L, et al. Prognostic significance of lymph node characteristics on survival in esophageal squamous cell carcinomas. Wien Klin Wochenschr, 2013, 125(1-2): 26-33.
6. Tachimori Y, Ozawa S, Numasaki H, et al. Efficacy of lymph node dissection by node zones according to tumor location for esophageal squamous cell carcinoma. Esophagus, 2016, 13: 1-7.
7. 杨丁, 毛友生. 食管癌手术入路和淋巴结清扫范围的选择. 中华胃肠外科杂志, 2016, 19(9): 1069-1072.
8. Sasako M, McCulloch P, Kinoshita T, et al. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg, 1995, 82(3): 346-351.
9. Udagawa H, Ueno M, Shinohara H, et al. The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol, 2012, 106(6): 742-747.
10. Miyata H, Sugimura K, Motoori M, et al. Clinical features of metastasis from superficial squamous cell carcinoma of the thoracic esophagus. Surgery, 2019, 166(6): 1033-1040.
11. Altorki NK, Zhou XK, Stiles B, et al. Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg, 2008, 248(2): 221-226.
12. Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: An international study on the impact of extent of surgical resection. Ann Surg, 2008, 248(4): 549-556.
13. Rizk NP, Ishwaran H, Rice TW, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg, 2010, 251(1): 46-50.
14. Zheng YZ, Li XQ, Wang JY, et al. Impact of examined lymph node count for esophageal squamous cell carcinoma in patients who underwent right transthoracic esophagectomy. Ann Surg Oncol, 2021, 28(6): 3025-3033.
15. Ajani JA, D'Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(7): 855-883.
16. Tan Z, Ma G, Zhao J, et al. Impact of thoracic recurrent laryngeal node dissection: 508 patients with tri-incisional esophagectomy. J Gastrointest Surg, 2014, 18(1): 187-193.
17. 廖志振, 章文龙. 胸段食管癌喉返神经旁淋巴结清扫的临床应用价值. 江西医药, 2021, 56(8): 1162-1164.
18. Shang QX, Yang YS, Hu WP, et al. Prognostic significance and role of thoracic lymph node metastasis based on Chinese expert consensus in esophageal cancer. Ann Transl Med, 2019, 7(16): 381.
19. Wang WP, Ni PZ, Yang YS, et al. The role and prognostic significance of aortopulmonary, anterior mediastinal, and tracheobronchial lymph nodes in esophageal cancer: Update of the eighth-edition TNM staging system (2018). Ann Surg Oncol, 2019, 26(4): 1005-1011.
20. Chao YK, Hsieh MJ, Liu YH, et al. Lymph node evaluation in robot-assisted versus video-assisted thoracoscopic esophagectomy for esophageal squamous cell carcinoma: A propensity-matched analysis. World J Surg, 2018, 42(2): 590-598.
21. Motoyama S, Sato Y, Wakita A, et al. Extensive lymph node dissection around the left laryngeal nerve achieved with robot-assisted thoracoscopic esophagectomy. Anticancer Res, 2019, 39(3): 1337-1342.
22. Tong C, Xu Y, Cao H, et al. Short-term outcomes of robot-assisted versus thoracoscopic-assisted minimally invasive esophagectomy. Ann Thorac Surg, 2021, S0003-4975(21): 01304-7.
23. 徐杨, 申翼. 达芬奇机器人在食管外科中的应用. 医学研究生学报, 2021, 34(1): 1-7.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effectiveness of lymphadenectomy of 1 061 patients based on the grouping of esophageal cancer lymph nodes by Chinese expert consensus: A retrospective analysis in a single center

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