초록접수 현황
| 19F-140 | 구연 발표 |
The Prognostic Importance of the Number of Dissected Recurrent Laryngeal Nerve Lymph Node after Radical Esophagectomy for Early-Stage Esophageal Squamous Cell Carcinoma
Tae Hee Hong, You Jin Ha, Genehee Lee, Sumin Shin, Jong Ho Cho, Hong Kwan Kim, Yong Soo Choi, Jae Ill Zo, Young Mog Shim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Purpose : Controversies exist on whether to perform radical dissection of the recurrent laryngeal nerve-lymph node (RLN-LN) for early-stage esophageal squamous-cell carcinoma (ESCC). We hypothesized that greater number of RLN-LN dissection improves oncologic outcome within the acceptable postoperative complications.
Methods : From 2001 to 2016, a total of 567 consecutive patients were identified to harbor early-stage(pT1N0) ESCC after curative esophagectomy. The cutoff-point analysis was performed to find the optimal number of RLN-LNs. After the validation in the entire cohort, we used this cutoff-value to define two groups (sufficient vs. insufficient RLN-LN) and compared clinical outcomes.
Results : The optimal number of dissected RLN-LN was four, calculated at the point of best-predicted recurrence. In the analysis of entire cohort, the sufficient-RLN dissection (≥4ea) is strongly associated with decreased loco-regional recurrence (multivariate OR=0.25, P<0.0001) as well as increased recurrence-free survival (RFS) (multivariate HR=0.58, P<0.001). The sufficient-RLN group showed significantly improved 5-year RFS not only before propensity-score (PS) matching (74.6% vs. 62.6%, log-rank P=0.00067) but also after PS matching (76.2% vs 62.6%, log-rank P=0.0081). The oncologic benefit of a greater number of dissected RLN became prominent in tumors of upper/middle-thoracic location and pathologicT1b tumors. However, hospital mortality, 30-day morbidity, and RLN-related complications were not significantly different between the two groups.
Conclusion : For the early-stage ESCC, the number of dissected RLN-LN (cutoff=4) is an independent risk factor for locoregional failure and decreased RFS after surgery. Thorough dissection for RLN-LNs should be warranted especially in upper/middle-thoracic and T1b ESCCs. Prudent follow-up strategies are required in pT1N0 patients with insufficient (<4) RLN-LN dissection.
Methods : From 2001 to 2016, a total of 567 consecutive patients were identified to harbor early-stage(pT1N0) ESCC after curative esophagectomy. The cutoff-point analysis was performed to find the optimal number of RLN-LNs. After the validation in the entire cohort, we used this cutoff-value to define two groups (sufficient vs. insufficient RLN-LN) and compared clinical outcomes.
Results : The optimal number of dissected RLN-LN was four, calculated at the point of best-predicted recurrence. In the analysis of entire cohort, the sufficient-RLN dissection (≥4ea) is strongly associated with decreased loco-regional recurrence (multivariate OR=0.25, P<0.0001) as well as increased recurrence-free survival (RFS) (multivariate HR=0.58, P<0.001). The sufficient-RLN group showed significantly improved 5-year RFS not only before propensity-score (PS) matching (74.6% vs. 62.6%, log-rank P=0.00067) but also after PS matching (76.2% vs 62.6%, log-rank P=0.0081). The oncologic benefit of a greater number of dissected RLN became prominent in tumors of upper/middle-thoracic location and pathologicT1b tumors. However, hospital mortality, 30-day morbidity, and RLN-related complications were not significantly different between the two groups.
Conclusion : For the early-stage ESCC, the number of dissected RLN-LN (cutoff=4) is an independent risk factor for locoregional failure and decreased RFS after surgery. Thorough dissection for RLN-LNs should be warranted especially in upper/middle-thoracic and T1b ESCCs. Prudent follow-up strategies are required in pT1N0 patients with insufficient (<4) RLN-LN dissection.
첨부파일 : RLN_KTCVS_submission.pptx
책임저자: Young Mog Shim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
발표자: Tae Hee Hong, E-mail : taehee888@naver.com