Original article
General thoracic
A Strategy for Supraclavicular Lymph Node Dissection Using Recurrent Laryngeal Nerve Lymph Node Status in Thoracic Esophageal Squamous Cell Carcinoma

https://doi.org/10.1016/j.athoracsur.2013.03.069Get rights and content

Background

The desirability of supraclavicular lymph node (LN) dissection, which is the cervical part of three-field LN dissection, has been discussed for a long time. In this study, we examine the pattern of supraclavicular LN metastasis in esophageal cancer, with a particular focus on the correlation between recurrent laryngeal nerve (RLN) LN and supraclavicular LN metastasis.

Methods

In all, 220 cases of R0 resected T1 to T3 squamous cell carcinomas were retrospectively examined. All of these patients underwent bilateral RLN LNs dissection; none received cancer treatment before surgery.

Results

Of 21 upper esophageal cancer cases, 33.3% of the patients had metastasis in the supraclavicular LN. Every patient in whom supraclavicular LN metastasis developed had metastasis in the RLN LN. Of 141 cases of middle esophageal cancer, 19.1% had metastasis in the supraclavicular LN. Among the patients whose RLN LN metastasized, 38.3% had metastasis in the supraclavicular LN. A similar correlation between RLN LN and supraclavicular LN metastasis was observed in lower esophageal cancer cases, especially in T3 cases. When considering cancers of the esophagus and patients who had metastasis in the supraclavicular LN, our data demonstrated that RLN LN metastasis did not always lead to metastasis on the same side of the supraclavicular LN.

Conclusions

The status of the RLN LN can be an indicator of supraclavicular LN dissection in upper esophageal cancer patients and advanced cases of middle and lower esophageal cancer patients. Bilateral supraclavicular LN dissection should be recommended even when only unilateral RLN LN metastasis occurs.

Section snippets

Patients and Methods

From January 1986 to 2011, 926 patients with esophageal cancer underwent esophagectomy in our single institution. Among them, we selected patients according to the following criteria to obtain the exact data of RLN LN state and exclude residual cancer cases: (1) T1 to T3 squamous cell carcinoma cases; (2) underwent the McKeown procedure; (3) a bilateral RLN LN dissection was performed; (4) an R0 resection was done; (5) the surgical margin was pathologically negative; (6) there was no treatment

Results

The clinical and pathologic characteristics of the study population are summarized in Table 1. Nineteen patients had cancer metastasis in the SC LN at the time of surgery and 22 patients had metastasis in the SC LN after surgery. Among 22 cases, 3 cases had lung metastasis and 2 cases had liver metastasis at the same time that SC LN metastasis had occurred. In upper esophageal cancer cases, 66.7% of the patients had RLN LN metastasis and 33.3% had SC LN metastasis (Table 2). Among all patients

Comment

The LN dissection of esophageal cancer patients has long been controversial. Because the frequency of metastasis around the RLN has been well known in thoracic esophageal cancer patients 1, 2, 3, 4, there would be no argument about dissecting these LNs. Moreover, because there is no obvious borderline between the thoracic and cervical RLN, we should dissect the LNs around the cervical RLN as well. In the UICC seventh edition, the cervical paraesophageal LN was defined as regional LN. Because

References (20)

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