Hagens Eliza R C, Kingma B Feike, van Berge Henegouwen Mark I, Borggreve Alicia S, Ruurda Jelle P, van Hillegersberg Richard, Gisbertz Suzanne S
Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Cancers (Basel). 2025 Mar 5;17(5):888. doi: 10.3390/cancers17050888.
To investigate the impact of paratracheal lymphadenectomy on survival in patients undergoing an esophagectomy for cancer. The secondary objective was to assess the effect on short-term outcomes. Between 2011-2017, patients with an esophageal or gastroesophageal junction carcinoma treated with elective transthoracic esophagectomy with two-field lymphadenectomy were included from the Dutch Upper Gastro-intestinal Cancer Audit registry. After 1:1 propensity score matching of patients with and without paratracheal lymphadenectomy within histologic subgroups, short-term outcomes and overall survival were compared between the two groups. A total of 1154 patients with adenocarcinoma and 294 patients with squamous cell carcinoma were matched. Lymph node yield was significantly higher (22 versus 19 nodes, < 0.001) in patients with paratracheal lymphadenectomy for both tumor types. Paratracheal lymphadenectomy was associated with more recurrent laryngeal nerve injury (10% versus 5%, = 0.002) and chylothorax in patients with adenocarcinoma (10% versus 5%, = 0.010) and with more anastomotic leakage in patients with squamous cell carcinoma (42% versus 27%, = 0.014). The 3- and 5-year survival in patients with and without a paratracheal lymphadenectomy were for adenocarcinoma, respectively, 58% versus 56% and 48% in both groups (log rank: = 0.578) and for patients with a squamous cell carcinoma, 62% in both groups and 57% versus 54% (log rank: = 0.668). The addition of paratracheal lymphadenectomy significantly increases lymph node yield in transthoracic esophagectomy but did not result in improved survival for esophageal cancer patients in the current dataset. However, there was an increase in postoperative morbidity in patients who underwent a paratracheal lymphadenectomy.
探讨气管旁淋巴结清扫术对食管癌患者行食管切除术后生存的影响。次要目标是评估其对短期结局的影响。2011年至2017年间，从荷兰上消化道癌症审计登记处纳入接受选择性经胸食管切除术加两野淋巴结清扫术治疗的食管或胃食管交界癌患者。在组织学亚组内对有和无气管旁淋巴结清扫术的患者进行1:1倾向评分匹配后，比较两组的短期结局和总生存。共匹配了1154例腺癌患者和294例鳞状细胞癌患者。两种肿瘤类型中，行气管旁淋巴结清扫术的患者淋巴结收获数显著更高（分别为22枚和19枚淋巴结，<0.001）。气管旁淋巴结清扫术与喉返神经损伤增加相关（分别为10%和5%，=0.002），腺癌患者乳糜胸增加（分别为10%和5%，=0.010），鳞状细胞癌患者吻合口漏增加（分别为42%和27%，=0.014）。有和无气管旁淋巴结清扫术患者的3年和5年生存率，腺癌患者两组分别为58%对56%和48%（对数秩检验：=0.578），鳞状细胞癌患者两组均为62%，分别为57%对54%（对数秩检验：=0.668）。在经胸食管切除术中增加气管旁淋巴结清扫术显著增加了淋巴结收获数，但在当前数据集中并未改善食管癌患者的生存。然而，行气管旁淋巴结清扫术的患者术后发病率有所增加。
