Comparison of Survival and Recurrence Pattern Between Two-Field and Three-Field Lymph Node Dissections for Upper Thoracic Esophageal Squamous Cell Carcinoma

Introduction: It is controversial to routinely perform three-field lymph node dissection in patients with upper thoracic esophageal carcinoma. The objective of this study was to compare survival and recurrence according to the extent of lymph node dissection in patients with upper thoracic esophageal squamous cell cancer. Methods: Between 1995 and 2007, 91 patients underwent R0 esophagectomy (with no residual tumor) for squamous cell carcinoma of the upper thoracic esophagus at our institution. Of these, 57 patients received three-field (cervical, mediastinal, and abdominal stations) lymph node dissection (3 FL group), whereas 34 received two-field (mediastinal and abdominal stations) lymph node dissection (2 FL group). We retrospectively compared the early and late postoperative outcomes between the two groups. Results: No differences were observed between the two groups with regard to age, gender, and pathologic stage. There was no in-hospital mortality in either group. The 5-year survival rate was 52% for the 2 FL group and 44% for the 3 FL group (p = 0.65). The disease-free 5-year survival rate was 39% for the 2 FL group and 38% for the 3 FL group (p = 0.97). The overall recurrence rate and the incidence of cervical nodal recurrence were not significantly different between the two groups. Conclusions: Our findings suggest that there was no survival benefit from the addition of cervical nodal dissection in patients with upper thoracic esophageal squamous cell carcinoma who had no evidence of cervical lymph node metastasis.