Optimizing lymph node dissection for accurate nodal staging in early-stage esophageal squamous cell carcinoma: a multicenter study

초록

BackgroundTo confirm the accurate pN0 status in patients with cT1-2N0 esophageal squamous cell carcinoma (ESCC) and recommend an optimal lymph node (LN) count for accurate nodal staging.MethodsA total of 1855 patients who underwent upfront surgery for cT1-2N0 ESCC at two tertiary academic hospitals in Korea between 1995 and 2019 were included. The probability of false-negative lymphadenectomy and the Nodal Staging Score (NSS) were calculated to assess adequate staging.ResultsThe mean age was 63.4 +/- 8.0 years, with 93.1% male patients. The mean number of dissected LNs was 34.7 +/- 14.0. The clinical T stages were cTis and cT1a 354 (19.1%), cT1b 1,053 (56.8%), and cT2 448 (24.2%). Pathological nodal upstaging occurred in 448 (24.2%) patients, with 337 (18.2%) pN1, 94 (5.1%) pN2, and 17 (0.9%) pN3. The analysis indicated that removing fewer than 33 LNs was associated with a 20% risk of missing metastatic nodes, whereas dissecting 53 nodes reduced this risk to 10%. Although overall survival improved with an increasing number of dissected LNs, the benefits plateaued beyond 33 LNs. The NSS, which indicates the likelihood that a patient with pN0 truly has no occult nodal disease, increased with the number of LNs dissected.ConclusionsWe recommend extensive dissection of at least 33 LNs during esophagectomy for accurate staging and to minimize the risk of undetected positive LNs in early-stage ESCC.

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