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Three-Field Versus Two-Field Lymphadenectomy in Minimally Invasive Esophagectomy: 3-Year Survival Outcomes of a Randomized Trial

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Minimally invasive esophagectomy (MIE) has been used widely for the treatment of esophageal cancer. However, the optimal extent of lymphadenectomy for esophagectomy in MIE remains unclear. This trial aimed to investigate the 3-year survival and recurrence outcomes in a randomized controlled trial comparing MIE with either three-field lymphadenectomy (3-FL) or two-field lymphadenectomy (2-FL).

Methods

Between June 2016 and May 2019, 76 patients with resectable thoracic esophageal cancer were enrolled in a single-center randomized controlled trial and randomly assigned to MIE that included either 3-FL or 2-FL at a 1:1 ratio (n = 38 patients each). The survival outcomes and recurrence patterns were compared between the two groups.

Results

The 3-year cumulative overall survival (OS) probability was 68.2 % (95 % confidence interval [CI], 52.72–83.68 %) for the 3-FL group and 68.6 % (95 % CI, 53.12–84.08 %) for the 2-FL group. The 3-year cumulative probability of disease-free survival (DFS) was 66.3 % (95 % CI, 50.03–82.57 %) for the 3-FL group and 67.1 % (95 % CI, 51.03–83.17 %) for the 2-FL group.. The OS and DFS differences in the two groups were comparable. The overall recurrence rate did not differ significantly between the two groups (P = 0.737). The incidence of cervical lymphatic recurrence in the 2-FL group was higher than in the 3-FL group (P = 0.051).

Conclusions

Compared with 2-FL in MIE, 3-FL tended to prevent cervical lymphatic recurrence. However, it was not found to add survival benefit for the patients with thoracic esophageal cancer.

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Acknowledgment

This study was supported by the Capital Clinical Features Project of Beijing Municipal Science and Technology Commission (Z161100000516185), the National Natural Science Foundation of China (No. 81902433), and the Medical Big Data and Artificial Intelligence Project of Chinese PLA General Hospital (2019MBD-027). The authors express their gratitude to EditSprings (https://www.editsprings.cn ) for the expert linguistic services provided.

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Author notes

  1. Boshi Fan and Zengfeng Sun have contributed equally to this report.

Authors and Affiliations

  1. Department of Thoracic Surgery, The Sixth Medical Center of Chinese, PLA General Hospital, Beijing, China

    Boshi Fan MD, Zengfeng Sun MD, Jing Lu MD, JunQiang Liu MD, Jiahua Zhao MD, Shaohua Zhou MD, Shouyin Di MD, Weian Song MD & Taiqian Gong MD

  2. The Second Clinical College of Southern Medical University, Guangzhou, China

    Taiqian Gong MD

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  1. Boshi Fan MD
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Correspondence to Weian Song MD or Taiqian Gong MD.

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Fan, B., Sun, Z., Lu, J. et al. Three-Field Versus Two-Field Lymphadenectomy in Minimally Invasive Esophagectomy: 3-Year Survival Outcomes of a Randomized Trial. Ann Surg Oncol 30, 6730–6736 (2023). https://doi.org/10.1245/s10434-023-13748-1

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