Purpose:To investigate the impact of paratracheal lymphadenectomy on survival in patients undergoing an esophagectomy for cancer. The secondary objective was to assess the effect on short-term outcomes.Methods:Between 2011–2017, patients with an esophageal or gastroesophageal junction carcinoma treated with elective transthoracic esophagectomy with two-field lymphadenectomy were included from the Dutch Upper Gastro-intestinal Cancer Audit registry. After 1:1 propensity score matching of patients with and without paratracheal lymphadenectomy within histologic subgroups, short-term outcomes and overall survival were compared between the two groups.Results:A total of 1154 patients with adenocarcinoma and 294 patients with squamous cell carcinoma were matched. Lymph node yield was significantly higher (22 versus 19 nodes,p< 0.001) in patients with paratracheal lymphadenectomy for both tumor types. Paratracheal lymphadenectomy was associated with more recurrent laryngeal nerve injury (10% versus 5%,p= 0.002) and chylothorax in patients with adenocarcinoma (10% versus 5%,p= 0.010) and with more anastomotic leakage in patients with squamous cell carcinoma (42% versus 27%,p= 0.014). The 3- and 5-year survival in patients with and without a paratracheal lymphadenectomy were for adenocarcinoma, respectively, 58% versus 56% and 48% in both groups (log rank:p= 0.578) and for patients with a squamous cell carcinoma, 62% in both groups and 57% versus 54% (log rank:p= 0.668).Conclusions:The addition of paratracheal lymphadenectomy significantly increases lymph node yield in transthoracic esophagectomy but did not result in improved survival for esophageal cancer patients in the current dataset. However, there was an increase in postoperative morbidity in patients who underwent a paratracheal lymphadenectomy.
目的：探讨食管癌切除术中行气管旁淋巴结清扫对患者生存率的影响。次要目标是评估其对短期预后的影响。 方法：从荷兰上消化道癌症审计登记处纳入2011年至2017年间接受择期经胸食管切除术联合两野淋巴结清扫术治疗的食管癌或胃食管结合部癌患者。在组织学亚组内，对接受与未接受气管旁淋巴结清扫的患者进行1:1倾向评分匹配后，比较两组患者的短期预后和总生存率。 结果：共匹配了1154例腺癌患者和294例鳞状细胞癌患者。对于两种肿瘤类型，接受气管旁淋巴结清扫的患者淋巴结获取数量均显著更高（22枚对19枚，p < 0.001）。气管旁淋巴结清扫与腺癌患者喉返神经损伤（10%对5%，p = 0.002）和乳糜胸（10%对5%，p = 0.010）发生率增加相关，并与鳞状细胞癌患者吻合口漏发生率增加相关（42%对27%，p = 0.014）。接受与未接受气管旁淋巴结清扫的患者，其3年和5年生存率分别为：腺癌患者组，58%对56%，以及两组均为48%（时序检验：p = 0.578）；鳞状细胞癌患者组，两组均为62%，以及57%对54%（时序检验：p = 0.668）。 结论：在经胸食管切除术中增加气管旁淋巴结清扫可显著提高淋巴结获取数量，但在当前数据集中并未改善食管癌患者的生存率。然而，接受气管旁淋巴结清扫的患者术后并发症发生率有所增加。
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