초록접수 현황
| 16F-012 | 포럼 발표 |
Pattern of Cervical Lymph node Metastasis and Efficacy of Cervical node Dissection in Esophageal Cancer
Yoonjin Kang, M.D., Kwanyong Hyun, M.D., Samina Park, M.D., Yoohwa Hwang, M.D., Hyun-Ju Lee, M.D., In kyu Park, M.D., Young Tae Kim, M.D., Chang Hyun Kang, M.D.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Background : The clinical importance of 3-field lymph node dissection (3FLND) in esophageal squamous cell carcinoma (ESCC) remains controversial. This study is to determine the pattern and the prognostic significance of cervical lymph node metastases (CLNM) from ESCC according to location of metastasis.
Methods : A retrospective review of 77 consecutive patients with ESCC who underwent esophagectomy and 3FLND between 2002 and 2016 was performed. For each cervical node level, efficacy index (EI), overall survival, recurrence rate, and complication rate were compared according to locations of CLNM. Location of CLNM was evaluated by CLNM map from American Joint Committee on Cancer
Results : CLNM occurred in 34 patients (44.2%) who underwent 3FLND. The occult metastasis rate of cervical node was 26.9%. Patients with CLNM had significantly lower overall survival (22.7% vs. 58.2%) and higher recurrence rate (45.9% vs. 16.3%) than the patients without CLNM. CLNM was one of the independent predictors of recurrence in patients with ESCC. Moreover, in patients with pathologic N3 tumors, the odds ratio of CLNM was 10.8 (95% C.I. 2.0-57.5, P=0.005). Location based analysis revealed that the level IV dissection had the highest EI and Level IV metastasis was significantly correlated with overall survival (p=0.012) and recurrence (p=0.001). Odds ratio of recurrent nerve palsy was highest (HR 6.882, p=0.001) with level VI dissection.
Conclusion : 3FLND is recommended for patients with ESCC in those with advanced nodal stages. According to the pattern of cervical metastasis, level IV is at highest risk of metastasis and dissection of level IV should be mandatory when performing 3FLND.
Methods : A retrospective review of 77 consecutive patients with ESCC who underwent esophagectomy and 3FLND between 2002 and 2016 was performed. For each cervical node level, efficacy index (EI), overall survival, recurrence rate, and complication rate were compared according to locations of CLNM. Location of CLNM was evaluated by CLNM map from American Joint Committee on Cancer
Results : CLNM occurred in 34 patients (44.2%) who underwent 3FLND. The occult metastasis rate of cervical node was 26.9%. Patients with CLNM had significantly lower overall survival (22.7% vs. 58.2%) and higher recurrence rate (45.9% vs. 16.3%) than the patients without CLNM. CLNM was one of the independent predictors of recurrence in patients with ESCC. Moreover, in patients with pathologic N3 tumors, the odds ratio of CLNM was 10.8 (95% C.I. 2.0-57.5, P=0.005). Location based analysis revealed that the level IV dissection had the highest EI and Level IV metastasis was significantly correlated with overall survival (p=0.012) and recurrence (p=0.001). Odds ratio of recurrent nerve palsy was highest (HR 6.882, p=0.001) with level VI dissection.
Conclusion : 3FLND is recommended for patients with ESCC in those with advanced nodal stages. According to the pattern of cervical metastasis, level IV is at highest risk of metastasis and dissection of level IV should be mandatory when performing 3FLND.
첨부파일 : figure and table.docx
책임저자: Chang Hyun Kang
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
발표자: Yoonjin Kang, E-mail : yoonjin.r.kang@gmail.com