Current surgical treatment for esophageal cancer

Indication and limitation of 3-field lymph node dissection surgery based on survival analysis

Abstract

Three-field lymph node dissection surgery for esophageal cancer was developed in Japan in order to achieve a better survival. However, this surgery requires a high degree of skill, and the morbidity and mortality rate of this surgery is higher than that for other gastrointestinal malignancies. This study investigated the proper indication and actual limitations of this surgery. Survived benefit of lymph node dissection was achieved when the number of lymph node metastase was five or less. However, when the number of lymph node metastase was more than five, mean survival time and Five-year survival rate decreased sharply. 5-year survival rate after 3-field lymph node dissection surgery for stage 2, 3 esophageal cancer was almost 60%, which was superior to that of definitive chemoradiation therapy. The number of lymph node metastase remained as the most powerful prognostic factor after 3-field lymph node dissection surgery. The development of a new effective systemic treatment for advanced esophageal cancer with multiple lymph node metastases is needed in order to improve the control of lymph node metastases.