Prognosis of Isolated Cervical Node Recurrence After Esophagectomy With Two-Field Lymphadenectomy for Esophageal Squamous Cell Carcinoma.

Abstract

Three-field lymph node dissection during esophagectomy for thoracic esophageal squamous cell carcinoma is controversial because of higher morbidity and uncertain survival benefits compared with 2-field lymph node dissection (2FL). Isolated cervical/supraclavicular lymph node recurrence (ICLNR) after 2FL shows better prognosis than other recurrences. We investigated clinical features and prognosis of ICLNR after 2FL. This retrospective study analyzed patients with recurrence after upfront esophagectomy with 2FL for mid to lower thoracic esophageal squamous cell carcinoma. The primary end point was overall survival (OS); the secondary end point was post-recurrence survival. Of 550 patients experiencing recurrence, ICLNR occurred in 69 cases (12.5%). Patients with ICLNR demonstrated better 5-year OS than patients with other recurrences (38.1% vs 22.2%; P = .002). Three-year post-recurrence survival was 62.5% after surgery, 61.4% after chemoradiotherapy, 38.4% after chemotherapy, and 32.5% after radiotherapy. Longer disease-free interval and definitive local salvage were associated with better OS. ICLNR after 2FL showed favorable outcomes with definitive local salvage treatment. Prospective multicenter studies are needed to clarify optimal management of ICLNR.