Prognostic significance of lymph node metastasis in surgical resection of esophageal cancer.

OBJECTIVE

Although surgery is relatively successful in eradicating local tumor, post-resection five-year survival rate for esophageal cancer is still lower than 30%. Multiple factors are found to influence the long-term results after surgical treatment. However, recent investigations have focused on the significance of lymph node matastasis (LNM), which seems to be one of the most important factors leading to poor survival. Hence, the prognostic significance of LNM in surgical resection of esophageal cancer was studied.

METHODS

The rate and degree of LNM were evaluated and their prognostic significance was investigated through a retrospective study of 474 patients with esophageal cancer treated by surgery alone.

RESULTS

LNM was positive in 211 patients, with an incidence of 44.5% (211/474). A total of 5382 lymph nodes were resected and studied pathologically, among which metastasis was found in 690 nodes with an overall LNM degree of 12.8% (690/5382). The 5-year survival rate was 30.6% (145/474) in the entire series, 12.8% (27/211) in patients with LNM, and 44.9% (118/263) in those without LNM.

CONCLUSIONS

Surgery remains the first choice of treatment for carcinoma of the esophagus, and that meticulous lymph node dissection is an important practice of surgical oncology. However, in more advanced cases of this disease, surgery alone is of limited value in eradicating all cancer compromized tissue, and therefore the routine practice of extensive lymph node dissection in such cases may not be rewarding.