Three-field or two-field resection for thoracic esophageal cancer: a meta-analysis.
BACKGROUND
There have been many controversies about the optimal extent of lymphadenectomy for thoracic esophageal cancer, whether three-field lymphadenectomy is superior to two-field lymphadenectomy with respect to the 5-year survival rate and perioperative morbidities and mortality.


METHODS
A comprehensive search of PubMed and Embase for relevant studies comparing three-field and two-field lymphadenectomies for thoracic esophageal cancer was conducted using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses standards. Hazard ratios (HRs) were extracted from these studies to give pooled estimates of the effect of the two surgical procedures on the 5-year survival rate and perioperative morbidities and mortality.


RESULTS
Thirteen studies were included for analysis. Compared with two-field lymphadenectomy, three-field lymphadenectomy provided a higher 5-year survival rate (HR 0.64, 95% confidence interval [CI]: 0.56 to 0.73, p = 0.000) and incidence of anastomotic leakage (HR 1.46, 95% CI: 1.19 to 1.79, p = 0.000), with a comparative perioperative mortality (HR 0.64, 95% CI: 0.38 to 1.10, p = 0.110) and incidence of vocal cord palsy (HR 1.12, 95% CI: 0.82 to 1.54, p = 0.470) and pulmonary complications (HR 1.00, 95% CI: 0.89 to 1.12, p = 0.760).


CONCLUSIONS
Published evidence indicated that three- field lymphadenectomy could be a priority for thoracic esophageal cancer, especially for tumors with positive lymph nodes. Given the lack of large-sample randomized controlled studies, further evaluations are necessary.
Department of Thoracic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Ting
T
Ye
Yihua
Y
Sun
Yiliang
Y
Zhang
Yang
Y
Zhang
Haiquan
H
Chen
D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D014943:Global Health; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D009367:Neoplasm Staging; D015996:Survival Rate / Q000639:trends
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