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Skeletonizing En Bloc Esophagectomy Revisited: Oncologic Outcome in Association with the Presence of Thoracic Duct Lymph Nodes

 Ha Eun Kim  ;  Young Ho Yang  ;  Byung Jo Park  ;  Seong Yong Park  ;  In Kyung Min  ;  Dae Joon Kim 
 ANNALS OF SURGICAL ONCOLOGY, Vol.29(8) : 4909-4917, 2022-08 
Journal Title
Issue Date
Esophageal Neoplasms* / pathology ; Esophageal Squamous Cell Carcinoma* / pathology ; Esophagectomy ; Humans ; Lymph Node Excision ; Lymph Nodes / pathology ; Lymph Nodes / surgery ; Lymphatic Metastasis / pathology ; Neoplasm Recurrence, Local / pathology ; Neoplasm Staging ; Retrospective Studies ; Thoracic Duct / pathology ; Thoracic Duct / surgery
Background: Skeletonizing en bloc esophagectomy (SEBE) involves the removal of the esophagus en bloc with locoregional soft tissues and lymph nodes, including the thoracic duct (TD); however, its oncologic benefits remain unclear. We evaluated the impact of SEBE on oncologic outcomes in patients with esophageal squamous cell carcinoma.

Methods: Patients undergoing McKeown esophagectomy without neoadjuvant therapy between 2013 and 2019 were evaluated. Outcomes after SEBE were compared with those after conventional esophagectomy (CE) using propensity score-matched analysis.

Results: Overall, 232 patients were identified, including 133 patients with SEBE and 99 patients with CE. Lymph node metastasis along the TD was identified in 7.5% (10/133) of the SEBE group, and the incidence was closely related with the tumor invasion depth (2.2% in pT1 and 19.0% in pT2-3). Based on the propensity score, 180 patients (90 pairs) were analyzed. Tumor recurrence was identified in 24.4% and 12.2% of CE and SEBE cases, respectively (p = 0.036). The observed difference was due to the higher incidence of locoregional recurrence in CE (10.5% vs. 2.2%; p = 0.024), while the incidence of systemic recurrence was similar (18.6% vs. 12.2%; p = 0.240). The 5-year disease-free survival rate was 83.6% and 62.4% in the SEBE and CE groups, respectively (p = 0.022). Multivariate analysis revealed that SEBE could significantly reduce the risk of recurrence or death in patients with pT2-3 tumors (hazard ratio 0.173, 95% confidence interval 0.048-0.628; p = 0.008).

Conclusions: SEBE could identify and eradicate lymphatic metastasis along the TD and positively impact disease-free survival, particularly in patients with pT2-3 tumors.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Kim, Ha Eun(김하은)
Park, Byung Jo(박병조)
Park, Seong Yong(박성용) ORCID logo https://orcid.org/0000-0002-5180-3853
Yang, Young Ho(양영호)
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