Mode of lymphadenectomy and surgical outcome of upper thoracic esophageal squamous cell carcinoma.

摘要

INTRODUCTION: Only a few studies have evaluated the impact of clinicopathological variables and cervical lymphadenectomy on survival in patients with upper thoracic esophageal squamous cell carcinoma (SCC). MATERIAL AND METHODS: From 1960 to 2005, a total of 167 consecutive patients with upper thoracic esophageal SCC underwent esophagectomy. Of these patients, 108 underwent surgery between 1960 and 1989 and 59 between 1990 and 2005. A total of 65 patients were treated with cervical lymphadenectomy. Univariate and multivariate analyses were performed to evaluate the impact of clinicopathological variables on surgical outcome and possible predictors for cervical lymph node metastasis. RESULTS AND DISCUSSION: The overall 5-year survival of the later period was significantly better than the former period (43% vs 13%, p < 0.01). Based on Cox's proportional hazards model, T3/T4 tumors, thoracic or abdominal node metastasis, venous invasion, residual cancer, absence of cervical lymphadenectomy, and hospital morbidity were independent risk factors for reduced survival in patients with upper thoracic esophageal SCC. A total of 31 (48%) of 65 patients who underwent cervical lymphadenectomy showed positive nodes in cervical field. CONCLUSION: Based on logistic regression analysis, T3/T4 tumors and recurrent nerve node metastasis were possible risk factors for cervical node metastasis.