Five Year Survival Of Thoracic Esophageal Cancer Treated By Two Kinds Of Lymph Node Dissection Methods: A Meta-Analysis

Background and Objective:Esophagus resection is the main therapy for the cancer of thoracic esophagus. It is controversial to routinely perform three-field lymph node dissection in patients with thoracic esophageal carcinoma.The objective of this study was to compare the five-year survival rate of thoracic esophageal cancer with three-field lymph node dissection and two-field lymph node dissection.Methods:A literature search (MEDLINE and CJFD) was performed, and all human studies published in the English-language literature between 1991 and 2011 comparing three-field lymph node dissection with two-field lymph node dissection for carcinoma of the thoracic esophagus. Included were prospective and retrospective comparative studies.Result:Eight articles were identified (Table 1). No differences were observed between the two groups with regard to age, gender, and pathologic stage. There were three prospective comparative studies, two of which were randomized. The other 5 comparative studies were retrospective.1717 patients were selected, of these,867 patients received three-field lymph node dissection (3 FL group), whereas 850 received two-field lymph node dissection(2 FL group). We compared the five-year survival between the two groups by using meta analysis. The 5-year survival rate was 47.6% for the 3 FL group and 37.6% for the 3 FL group, respectively. The relative risks (RR) was 1.31,95%CI[1.17,1.46], Z=4.75, P<0.00001<0.05, there were statistical significantly different between the two group.Conclusion:It was concluded that 5 year survival rate was significantly better in patients with extensive three-field dissection comparing to two-field lymph node dissection. Three-field lymph node dissection should be treat as the routine approach in cancer of the thoracic esophagus,in order to enhance the long-term survival.