Three-Field Lymphadenectomy in Minimally Invasive Esophagectomy for Squamous Cell Carcinoma

Background. Minimally invasive esophagectomy (MIE) has been used widely for the treatment of esophageal cancer. However, there is still a lack of consensus on the extent of lymphadenectomy in MIE. The objective of this study was to investigate the safety and efficacy of three-field lymphadenectomy (3-FL) in MIE, compared with the standard two-field lymphadenectomy (2-FL). Methods. A single-center randomized controlled trial was conducted, enrolling patients with resectable thoracic esophageal cancer (cT1-3,N0-3,M0) between June 2016 and May 2019. Eligible patients were randomized into two groups to receive either 3-FL or 2-FL during MIE procedures. Perioperative outcomes of the two groups were compared. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INR-16007957). Results. Seventy-six eligible patients were randomly assigned to the 3-FL group (n = 38) and the 2-FL group (n = 38). Compared with patients in the 2-FL group, patients in the 3-FL group had more lymph nodes harvested (54.7 +/- 16.5vs 30.9 +/- 9.6, P < .001) and more metastatic lymph nodes identified (3.5 +/- 4.5 vs 1.7 +/- 2.0, P = .027). Patients in the 3-FL group were diagnosed with a more advanced final pathologic TNM stage than patients in the 2-FL group. There was no significant difference between the two groups in blood loss, major postoperative complications, or duration of hospital stay, except that the operation time was longer in the 3-FL group than in the 2-FL group (270.5 +/- 45.4 minutes vs 236.7 +/- 47.0 minutes, P = .002). Conclusions. Three-field lymphadenectomy allowed harvesting of more lymph nodes and more accurate staging without increased surgical risks compared with 2FL MIE for esophageal cancer. (C) 2021 by The Society of Thoracic Surgeons

Automated summary

This study compared the efficacy of three-field lymphadenectomy (3-FL) with standard two-field lymphadenectomy (2-FL) in minimally invasive esophagectomy (MIE) for esophageal cancer. The results showed that 3-FL allowed for more lymph nodes harvest and accurate staging without increased surgical risks, despite longer operation time compared to 2-FL.