Beside The Intrathoracic Esophageal Squamous Carcinoma, Laryngeal Recurrent Nerve Indicative Of Lymph Node Metastasis Of Cervical Lymph Nodes And Relevant Sanye Surgical Indications

Background and Objectives:Recurrent laryngeal nerve lymph nodes (RLN LNs) are one of the most frequent metastases lymph nodes which considered sentinel nodes for cervical LN metastases of esophageal cancer. Surgery is the treatment of choice, but whether three-field lymph node dissection (3FL), which includes cervical LN dissection, or2FL, which does not, should be performed is controversial.Therefore,people hope to find some indications as well as the patients suitable for the3FL.Methods:We retrospectively analyzed medical records of200patients with esophageal cancer who underwent3FL from January2000to August2010, focusing on LN status. We also compared survival rates between these patients and those who underwent2FL through follow-up.The frequencies of LN metastases were compared with the chi-square test, and the mean ages of the two groups were compared with the Student’s t-test. Survival was calculated from the date of surgery to the occurrence of death or the most recent follow-up visit. The survival times of the two groups were compared using the Kaplan-Meier method. Multivariate analysis were also performed to assess predictors for cervical lymph node metastasis and the element which affect the survival in3FL and2FL group by logistic and Cox regression. The HRs of3FL versus2FL were calculated using COX model adjusted for propensity score since other confounders, such as age at surgery, chemotherapy, are not balanced between3FL and2FL because of small sample size in the subgroup analysis. All statistical tests were performed with SPSS17.0software (IBM, Armonk, NY). P-value<0.05was considered significant.Results:The rate of cervical LN metastases was differ significantly between RLN LN+(for metastasis) and RLN LN-in3FL groups(P=0.041),and in a subgroup of patients with middle/lower thoracic esophageal tumors, cervical LN metastases were significantly more common in patients with positive rather than negative RLN LNs(P=0.003). But in the patients with upper thoracic esophageal tumors,the difference was not significant(P=0.275).Survival did not differ after3FL versus2FL in general. However,3FL was associated with longer survival than2FL in patients with RLN LN positivity and either lower thoracic esophageal tumors or more than four abdominal/thoracic LN metastases.Conclusions:Metastasis to RLN LNs is a reliable indicator of cervical LN metastasis in middle/lower thoracic esophageal cancer,but it is not a significant risk factor of overall survival.3FL could offers survival benefit over2FL in certain patient subgroups.