Characteristics of lymph node metastasis and short-term outcome of esophageal squamous-cell carcinoma undergoing minimally invasive esophagectomy: a prospective cross-sectional study (with video)

Duy Duc Nguyen; Binh Van Pham; Manh Dai Tran; Thanh Duy Nguyen; An Duc Thai; Ky Van Le; Vu Van Kim; Hung Xuan Nguyen

doi:10.1097/MS9.0000000000002500

Characteristics of lymph node metastasis and short-term outcome of esophageal squamous-cell carcinoma undergoing minimally invasive esophagectomy: a prospective cross-sectional study (with video)

Ann Med Surg (Lond). 2024 Sep 4;86(10):5739-5743. doi: 10.1097/MS9.0000000000002500. eCollection 2024 Oct.

Authors

Duy Duc Nguyen^{1

2}, Binh Van Pham², Manh Dai Tran², Thanh Duy Nguyen², An Duc Thai², Ky Van Le³, Vu Van Kim¹, Hung Xuan Nguyen⁴

Affiliations

¹ Hanoi Medical University.
² Department of Abdominal Surgery 1, Vietnam National Cancer Hospital.
³ Pathology and Molecular Biology Center, Vietnam National Cancer Hospital.
⁴ Hong Ngoc Hospital, Hanoi, Vietnam.

Abstract

Introduction: Surgery for esophageal squamous-cell carcinoma (ESCC) presents many potential challenges owing to malignant lymph node metastasis, complex procedures and severe postoperative complications. The appropriate lymphadenectomy for ESCC remains controversial. This study aims to evaluate the characteristics of lymph node metastasis and postoperative complications in patients with ESCC undergoing minimally invasive esophagectomy and extended two-field lymph node dissection.

Patients and methods: This prospective, single-center, cross-sectional study was conducted from October 2022 to May 2024. All patients with ESCC who underwent minimally invasive esophagectomy and extended two-field lymph node dissection were selected for this study. Postoperative lymph nodes were divided into upper thoracic, middle thoracic, lower thoracic and abdominal lymph node groups.

Results: Seventy-four patients with ESCC, including 49 patients who underwent upfront surgery and 25 patients who received preoperative chemoradiotherapy, were selected. The rate of lymph node metastasis in all patients was 39.2%, with 13.6% of patients having upper thoracic metastasis. The factors affecting the rate of lymph node metastasis included preoperative chemoradiotherapy, tumor stage, poor differentiation, lymphovascular/perineural invasion, and tumor size greater than 2 cm, all of which were significantly different (P<0.05). Common postoperative complications included pneumonia (25.7%), recurrent laryngeal nerve (RLN) palsy (10.8%) and anastomotic leak (4.1%). There were no cases required conversion to open surgery, nor any deaths within 90 days postoperatively.

Conclusion: Lymph node metastasis in esophageal squamous-cell carcinoma has a high incidence, occurs in the early stages, and is widely distributed in all regions of the mediastinum and abdomen. Minimally invasive esophagectomy and extended two-field lymph node dissection are feasible and safe, with low complication rates.

Keywords: esophageal squamous-cell carcinoma; extended two-field lymph node dissection; minimally invasive esophagectomy.