Retrospective Study
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World J Gastroenterol. Dec 21, 2014; 20(47): 17970-17975
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.17970
Effect of bilateral supraclavicular postoperative radiotherapy in middle and lower thoracic esophageal carcinoma
Yi Ren, Chang Su, Yang Zhou, Xiang Zhao, Cheng-Liang Yang, Yong-Yu Liu
Yi Ren, Yang Zhou, Xiang Zhao, Cheng-Liang Yang, Yong-Yu Liu, Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Dalian Medical University Clinical Oncology College, Shenyang 110042, Liaoning Province, China
Chang Su, Department of Ultrasound Diagnosis, People’s Hospital of Liaoning Province, Shenyang 110016, Liaoning Province, China
Author contributions: Ren Y and Liu YY designed research; Zhao X performed research; Su C contributed new reagents or analytic tools; Zhou Y analyzed data; Ren Y and Yang CL wrote the paper.
Supported by grant from Doctoral Startup Project of Liaoning Provincial Science and Technology Department, No. 20121133
Correspondence to: Yong-Yu Liu, Professor, Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Dalian Medical University Clinical Oncology College, 44 Xiaoheyan Road, Dadong District, Shenyang 110042, Liaoning Province, China. l24315516@sina.com
Telephone: +86-24-31916213 Fax: +86-24-24315679
Received: August 24, 2014
Revised: September 25, 2014
Accepted: October 21, 2014
Published online: December 21, 2014
Abstract

AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.

METHODS: A total of 530 cases with middle and lower thoracic esophageal carcinoma in our hospital from January 2008 to April 2009 were selected and analyzed, of which 219 cases received right chest, upper abdominal incision Ivor-Lewis surgery and simultaneously underwent mediastinal and abdominal two-field lymphadenectomy. If regional lymph node metastasis occurred within the recurrent laryngeal nerve, the patients would receive bilateral supraclavicular radiotherapy (DT = 5000cGy) to be adopted at postoperative 4-5 wk (Group A) or cervical lymphadenectomy at postoperative 3-4 wk (Group B). If there were no regional lymph node metastases within the recurrent laryngeal nerve, the patients only underwent two-field, chest and abdomen, lymphadenectomy (Group C).

RESULTS: In 219 cases who underwent two-field lymphadenectomy, 91 cases were diagnosed with regional lymph node metastasis within the recurrent laryngeal nerve. Of them, 48 cases received cervical radiotherapy, and 43 cases underwent staging lymphadenectomy; 128 patients were not given the follow-up treatment of cervical radiotherapy because there was no regional lymph node metastasis within the recurrent laryngeal nerve. Five-year survival rates in group A and B were 47% and 50%, respectively, with no statistical difference between them, and the rate in group C was 58%.

CONCLUSION: For patients with middle and lower thoracic esophageal carcinoma combined with lymph node metastasis within the recurrent laryngeal nerve, cervical radiotherapy can be a substitute for surgery and provide benefit.

Keywords: Middle and lower thoracic esophageal carcinoma, Lymph node metastasis, Bilateral supraclavicular postoperative radiotherapy

Core tip: Three-field lymphadenectomy is currently a focus in esophageal surgery. According to the patterns of lymph node metastasis, understanding of the lymph node status in the middle and lower recurrent laryngeal nerve region may predict the status of cervical lymph nodes. In patients who have received thoracic and abdominal lymphadenectomy, if lymph node metastasis of recurrent laryngeal nerve is indicated it will be especially important to subsequently treat cervical lymph nodes. Additional cervical lymphadenectomy is always performed clinically in this case. In this article, we discuss whether cervical surgical procedures can be replaced by radiotherapy.