Therapeutic Effect of Lymph Node Dissection After Neoadjuvant Chemoradiation Therapy Followed by Esophagectomy on Esophageal Squamous Cell Carcinoma Using the Efficacy Index

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BACKGROUND: The effect of lymph node (LN) dissection on the overall survival of patients with esophageal squamous cell carcinoma (ESCC) treated by neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy has been controversial. This study investigated the patterns of metastatic LNs after nCRT and the benefits of LN dissection using the efficacy index (EI). METHODS: The EI was calculated by multiplying the frequency (%) of metastases to a zone and the 5-year overall survival rate (%) of patients with metastases to that zone and then dividing by 100. EIs were compared according to the primary lesion location, response to nCRT, and preoperative radiation coverage. RESULTS: Among 573 patients, the mean age was 62.66 ± 8.10 years, and 533 (93.02%) were male. The mean number of dissected LNs was 37.62 ± 14.76. In all patients, bilateral recurrent laryngeal LNs and paracardial and left gastric LNs showed high EIs compared with other LN stations, and these patterns were maintained regardless of the primary lesion location. The EIs of bilateral recurrent laryngeal LNs and paracardial and left gastric LNs were still high in complete pathologic responders (ypT0) to nCRT and regardless of preoperative radiation coverage. CONCLUSION: In ESCC treated with nCRT followed by esophagectomy, the EI of LNs varied between stations. High EIs of bilateral recurrent laryngeal LNs and paracardial and left gastric LNs after nCRT revealed the importance of adequate and complete dissection of these LN stations regardless of the pathologic response to nCRT and the radiation coverage.

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