Pattern of lymph node metastasis and choice of lymphadenectomy in patients with thoracic esophageal squamous cancer / 中华胃肠外科杂志

ABSTRACT

Esophageal squamous cancer is a malignancy with high incidence and mortality. Surgery currently remains the most important part of the comprehensive treatments. The number of metastatic lymph node has great influence on the prognosis of esophageal cancer, so thorough lymphadenectomy also becomes a key factor. Meanwhile, the choice of lymphadenectomy procedure during surgery has always been controversial. In current article, we summarized the pattern in lymph node metastasis in thoracic esophageal squamous cell carcinoma by analyzing relevant literatures, and discovered that the longitudinal lymphatic network of the submucosa and the horizontal lymphatic pathways of the muscularis propria are the anatomical foundation of the lymph node metastasis of esophageal cancer. Then, we evaluated the impact of lymph node metastasis on the prognosis in terms of number of metastatic lymph node, distant metastasis, positive lymph node ratio, solitary metastasis, micrometastasis and extracapsular lymph node involvement. During surgery, should we choose two-field lymphadenectomy (2-FL) or three-field lymphadenectomy (3-FL)? The clinical efficacy was compared between 2-FL and 3-FL in this paper. The results showed that compared with patients who underwent 2-FL, those who underwent 3-FL had significantly higher 5-year survival rate, significantly longer operative time, and more dissected lymph nodes, while blood loss during surgery was not significantly different. As for complication, some studies indicated that patients after 3-FL had a significantly higher risk of anastomotic leakage, recurrent laryngeal nerve paralysis, and tracheal ischemia, while no significant differences in pulmonary infection and chylothorax were found. At last, we introduced the application of sentinel lymph node technique and relevant research evidence of recurrent laryngeal nerve lymph node as predictive markers for cervical lymph node metastasis.