Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.17970
Revised: September 25, 2014
Accepted: October 21, 2014
Published online: December 21, 2014
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.
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.