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Extent of Mediastinal Lymphadenectomy and Survival in Superficial Esophageal Squamous Cell Carcinoma

 Seong Yong Park  ;  Dae Joon Kim  ;  Taeil Son  ;  Yong Chan Lee  ;  Chang Young Lee  ;  Jin Gu Lee  ;  Kyung Young Chung 
 JOURNAL OF GASTROINTESTINAL SURGERY, Vol.21(10) : 1584-1590, 2017 
Journal Title
Issue Date
Aged ; Carcinoma, Squamous Cell/secondary ; Carcinoma, Squamous Cell/surgery* ; Disease-Free Survival ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery* ; Esophagectomy/adverse effects ; Female ; Humans ; Lymph Node Excision*/adverse effects ; Lymph Node Excision*/methods ; Lymphatic Metastasis ; Male ; Mediastinum/surgery* ; Middle Aged ; Neoplasm Recurrence, Local*/pathology ; Neoplasm Staging ; Recurrent Laryngeal Nerve ; Retrospective Studies ; Survival Rate
Esophagus ; Oncology ; Outcomes
BACKGROUND: The aim of this study is to investigate the utility of total mediastinal lymphadenectomy (ML) in superficial esophageal squamous cell carcinoma (ESCC).

METHODS: The medical records of 129 patients who underwent esophagectomy and lymph node dissection for pathologically confirmed pT1 ESCC between July 2006 and December 2014 were retrospectively reviewed. Limited ML, such as traditional 2-field or transhiatal esophagectomy, was performed in 42 patients (group 1), and total ML, including the bilateral recurrent laryngeal nerve nodes, was performed in 87 patients (group 2).

RESULTS: R0 resection was achieved in all patients, and the number of dissected nodes was 28.0 ± 11.4 and 44.8 ± 16.1 in groups 1 and 2 (p < 0.001), respectively. The complication profile was similar in the two groups, but there were two operative mortalities in group 2. During a median follow-up of 32.4 months, loco-regional failure was found in 14.3% of group 1 and 3.5% of group 2 (p = 0.001). There was a significant difference in the 3-year overall survival (95.1% in group 2 vs. 83.3% in group 1, p = 0.043), and the 3-year disease-free survival rates (92.3% in group 2 vs. 73.7% in group 1, p = 0.001). On multivariate analysis, the extent of ML (HR, 5.200; 95% CI, 1.532 ~ 17.645; p = 0.008) and pT1b lesion classification (HR, 4.747; 95% CI, 1.024 ~ 21.997; p = 0.047) was a factor predictive of disease-free survival.

CONCLUSIONS: Total ML might be beneficial, especially in cases of pT1b ESCC, because it could lead to a lower incidence of recurrence and longer survival times.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Park, Seong Yong(박성용) ORCID logo https://orcid.org/0000-0002-5180-3853
Son, Tae Il(손태일) ORCID logo https://orcid.org/0000-0002-0327-5224
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Jin Gu(이진구)
Lee, Chang Young(이창영)
Chung, Kyung Young(정경영)
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