Department of Thoracic Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, No 55, Zhenhai Road, Xiamen, Fujian, 361003, China.
J Cancer Res Clin Oncol. 2024 Aug 7;150(8):387. doi: 10.1007/s00432-024-05911-2.
This research aimed to clarify the metastatic patterns of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma and to investigate appropriate strategies for lymph node dissection.
Patients with thoracic esophageal squamous cell carcinoma receiving esophagectomy from December 2020 to April 2024 were retrospectively analyzed. Risk factors for subcarinal, right and left recurrent laryngeal nerve lymph nodes metastasis were determined by chi-square test and multivariate logistic regression analysis. We visualized the metastasis rates of these specific lymph nodes based on the different clinicopathological characteristics. Correlation between subcarinal, right and left recurrent laryngeal lymph nodes metastasis and postoperative complications were also analyzed.
A total of 503 thoracic esophageal squamous carcinoma patients who underwent esophagectomy were enrolled. The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes were 10.3%, 10.3%, and 10.9%, respectively. The lymphovascular invasion status and tumor location were the significant predictors for subcarinal and right recurrent laryngeal nerve lymph nodes metastasis, respectively (P < 0.001 and P = 0.013). For left recurrent laryngeal nerve lymph node metastasis, younger age (P = 0.020) and presence of lymphovascular invasion (P = 0.009) were significant risk factors. Additionally, pulmonary infection is the most frequent postoperative complication in patients with dissection of subcarinal, right and left recurrent laryngeal lymph nodes. There was no significant difference in the incidence of anastomotic leakage (P = 0.872), pulmonary infection (P = 0.139), chylothorax (P = 0.702), and hoarseness (P = 0.179) between the subcarinal lymph node dissection cohort and the reservation cohort. The incidence of hoarseness significantly increased in both right (P = 0.042) and left (P = 0.010) recurrent laryngeal nerve lymph nodes dissection cohorts compared by the reservation cohorts, with incidence rates of 5.9% and 6.7%, respectively.
The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma were all over 10%. The dissection of subcarinal lymph nodes does not increase postoperative complications risk, while recurrent laryngeal nerve lymph nodes dissection significantly increases the incidence of hoarseness. Thus, lymph node dissection of subcarinal lymph nodes should be conducted routinely, while recurrent laryngeal nerve lymph nodes dissection may be selectively performed in specific patients.
本研究旨在阐明胸段食管鳞癌发生于隆突下、右和左喉返神经淋巴结转移的模式，并探讨淋巴结清扫的合适策略。
回顾性分析 2020 年 12 月至 2024 年 4 月期间接受食管癌切除术的患者。采用卡方检验和多因素 logistic 回归分析确定隆突下、右和左喉返神经淋巴结转移的风险因素。基于不同的临床病理特征，我们直观地显示了这些特定淋巴结的转移率。还分析了隆突下、右和左喉返神经淋巴结转移与术后并发症之间的相关性。
共纳入 503 例接受食管癌切除术的胸段食管鳞癌患者。隆突下、右和左喉返神经淋巴结的转移率分别为 10.3%、10.3%和 10.9%。淋巴血管侵犯状态和肿瘤位置是隆突下和右喉返神经淋巴结转移的显著预测因子（P<0.001 和 P=0.013）。对于左喉返神经淋巴结转移，年龄较小（P=0.020）和存在淋巴血管侵犯（P=0.009）是显著的危险因素。此外，肺部感染是行隆突下、右和左喉返神经淋巴结清扫术患者最常见的术后并发症。在吻合口漏（P=0.872）、肺部感染（P=0.139）、乳糜胸（P=0.702）和声音嘶哑（P=0.179）的发生率方面，隆突下淋巴结清扫组与保留组之间无显著差异。与保留组相比，右（P=0.042）和左（P=0.010）喉返神经淋巴结清扫组的声音嘶哑发生率均显著增加，发生率分别为 5.9%和 6.7%。
胸段食管鳞癌中隆突下、右和左喉返神经淋巴结的转移率均超过 10%。行隆突下淋巴结清扫术不会增加术后并发症的风险，而喉返神经淋巴结清扫术显著增加声音嘶哑的发生率。因此，应常规行隆突下淋巴结清扫术，而喉返神经淋巴结清扫术可选择性地应用于特定患者。
