[Impact of different extents of lymph node dissection on the survival in stage III esophageal cancer patients].
OBJECTIVE
To investigate the safety, feasibility and the impact of different extents of lymph node dissection on the survival in the patients with locally advanced thoracic esophageal carcinoma.


METHODS
From January 2001 to December 2006, 122 patients with locally advanced thoracic esophageal carcinoma underwent radical resection through cervical, thoracic, and abdominal incisions, and were randomly divided into two-field lymph node dissection group (Two-FD) and three-field lymph node dissection group (Three-FD). Life-table method was used to compare the difference of survival rates between the two groups. Kaplan-Meier method was used to compare the cumulative survival time and median survival time between the two groups. Multivariate analysis was performed using Cox model to identify the prognostic factors affecting the survival (alpha = 0.05).


RESULTS
There was no significant difference between the two groups in age, sex, and disease stage. Postoperative complication rate and perioperative mortality rate were 14.5% and 1.6% in the two-FD group versus 15.0% and 1.7% in the three-FD group, statistically without a significant difference (P > 0.05). The 1-, 3- and 5-year survival rates were 78.2%, 39.6% and 14.5% in the two-FD group, and 83.7%, 42.4% and 18.1% in the three-FD group, respectively. The median survival time was 24.0 months in the two-FD group and 31.0 months in the three-FD group. Log-rank analysis showed that in the patients without preoperative weight loss, in T3N1M0 stage, only single regional lymph node metastasis but < 3 in total, the three field lymph node dissection achieved a better prognosis (P < 0.05). Multivariate analysis using Cox model showed that T and N stages and lymph node dissection extent were still risk factors in patients with stage III locally advanced thoracic esophageal carcinoma.


CONCLUSIONS
Compared with the two field lymph node dissection, the three field lymph node dissection is safe and feasible, and can improve the survival for a part of stage III esophageal cancer patients without increase in operative mortality and complications.
Zhang
Guo-qing
GQ
Department of Thoracic Surgery, Cancer Hospital, Xinjiang Medical University, Urumqi 830011, China. hf930131@qq.com
Han
Feng
F
Sun
Wei
W
Pang
Zuo-liang
ZL
SiKanDaer
A BuLiZi
AB
Wang
Hong-jiang
HJ
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002916:Chylothorax / Q000209:etiology; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D015996:Survival Rate
D002945:Cisplatin; D005472:Fluorouracil