Efficacy of lymph node dissection by node zones according to tumor location for esophageal squamous cell carcinoma

作者：Yuji Tachimori, Soji Ozawa, Hodaka Numasaki, Hisahiro Matsubara, Masayuki Shinoda, Yasushi Toh, Harushi Udagawa, Mitsuhiro Fujishiro, Tsuneo Oyama, Takashi Uno · 发表于：Esophagus · 年份：2015 · DOI：10.1007/s10388-015-0515-3 · 被引用次数：183 · 研究领域：Esophageal Cancer Research and Treatment、Breast Cancer Treatment Studies、Head and Neck Cancer Studies

BACKGROUND: The extent of node dissection in esophageal cancer surgery is usually estimated by the number of resected nodes, irrespective of the area of dissection. The efficacy of lymph node dissection by area was evaluated according to the location of the primary tumor. METHODS: The study group comprised the 3827 patients who underwent R0 esophagectomy with three-field lymph node dissection for squamous cell carcinoma, registered in a nationwide registry in Japan. The areas of lymph node were classified into zones according to AJCC Staging Manual. The Efficacy Index (EI) calculating the frequency and patient survival of metastases to each zone was investigated according to tumor location. RESULTS: The EI was high in supraclavicular and upper mediastinal zones in patients with upper esophageal tumors, highest in upper mediastinal zone followed by supraclavicular and perigastric zones in patients with middle esophageal tumors, and highest in perigastric zone followed by upper and lower mediastinal zones in patients with lower esophageal tumors. In patients with middle and lower esophageal cT1 tumors, the EIs of upper mediastinal and perigastric zones were higher than middle and lower mediastinal zones. CONCLUSION: The EIs of each zone were differed by tumor location. The extent of lymph node dissection should be estimated by the dissected zones and modified by the tumor location. Supraclavicular dissection is indispensable for patients with upper esophageal tumors, and recomm...