Pre-tracheal lymph node metastasis in squamous cell carcinoma of the thoracic esophagus

To clarify the incidence of pre-tracheal lymph node metastasis in squamous cell carcinoma of the esophagus, and their impact on survival. A cohort of 101 patients with squamous cell carcinoma of the thoracic esophagus who underwent esophagectomy together with 2-field lymphadenectomy including the pr...

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Bibliographic Details
Published in:European journal of surgical oncology 2005-09, Vol.31 (7), p.749-754
Main Authors: Hsu, C.P., Hsu, N.Y., Shai, S.E., Hsia, J.Y., Chen, C.Y.
Format: Article
Language:English
Subjects:
Adult
Aged
Cohort Studies
Esophageal cancer
Esophageal Neoplasms - epidemiology
Esophageal Neoplasms - pathology
Esophageal Neoplasms - surgery
Female
Humans
Incidence
Lymphadenectomy
Lymphatic Metastasis
Male
Middle Aged
Neoplasms, Squamous Cell - epidemiology
Neoplasms, Squamous Cell - secondary
Neoplasms, Squamous Cell - surgery
Pre-tracheal node
Prognosis
Retrospective Studies
Survival Analysis
Trachea - pathology
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Summary:To clarify the incidence of pre-tracheal lymph node metastasis in squamous cell carcinoma of the esophagus, and their impact on survival. A cohort of 101 patients with squamous cell carcinoma of the thoracic esophagus who underwent esophagectomy together with 2-field lymphadenectomy including the pre-tracheal region was analysed, retrospectively. The p-TNM staging included stage I in 9, stage IIa in 33, stage IIb in 4, stage III in 43, and stage IV in 12 cases. Nodal metastases were identified in 56 patients (55.4%). Subcarinal lymph node and pre-tracheal lymph-node metastases were found in 24 patients (23.8%) and 15 patients (14.9%), respectively. The 5-year cumulative survival rates were 26.5 and 2.5% in nodal negative and nodal positive patients, respectively. Patients with pre-tracheal nodal metastasis all died within 2 years. Cox proportional hazards model in patients with nodal involvement revealed T-factor (p=0.0017), pre-tracheal nodal involvement (p=0.0055) and distant metastasis (p=0.0024) as independent prognostic factors. Our findings suggest that pre-tracheal lymph node metastasis indicates a dismal prognosis. Its occurrence is not unusual, especially in tumour of upper or middle thoracic esophagus. The subcarinal node cannot be regarded as a sentinel node of the pre-tracheal nodal station. Complete lymphadenectomy excluding the pre-tracheal lymph nodes in treating esophageal cancers is only a myth.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2005.03.009