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. 2016 Oct;8(10):2803-2812.
doi: 10.21037/jtd.2016.10.34.

Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Shaobin Yu  1 , Jihong Lin  1 , Chenshu Chen  1 , Jiangbo Lin  1 , Ziyang Han  1 , Wenwei Lin  1 , Mingqiang Kang  1
Affiliations

Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Shaobin Yu et al. J Thorac Dis. 2016 Oct.

Abstract

Background: Recurrent laryngeal nerve (RLN) injury is one of the most frequent postoperative complications of esophageal squamous cell carcinoma (ESCC) radical resection. This study aims to develop a novel scoring system to predict recurrent laryngeal nerve lymph node (RLNLN) metastases in early ESCC and explore the indications for precise RLN lymphadenectomy.

Methods: Early stage ESCC patients from 2006 to 2014 were analyzed. Patient and pathologic characteristics were compared between patients with RLNLN metastases and those without. Univariate and multivariate analyses were performed to establish a scoring system that estimates the risks of RLNLN metastases. The indications for RLNLN dissection were validated by survival rate, postoperative complications, and metastases rate.

Results: A total of 311 cases selected from 1,466 ESCC patients were divided into the dissection group and the control group. Age, tumor length, macroscopic tumor type, T stage, tumor location and tumor differentiation were independent predictors of RLNLN metastases. The weighted scoring system included age (+2 for <56 years), tumor length (+2 for over 4.45 cm), tumor location (+4 for upper thoracic, +2 for mid-thoracic) and macroscopic tumor type (+1 for advanced type). The total number of points estimated the probability of RLNLN metastases [low-risk (0-2 point), 0%; moderate-risk (3-4 points), 9.8%; and high-risk (>4 points), 43.4%]. Besides, the dissection group had more complications and similar survival rate when compared with the control group.

Conclusions: We developed a novel scoring system that accurately estimated the risk of RLNLN metastases in early ESCC patients. RLN lymphadenectomy may be safely omitted for the patients in the low-risk subgroup.

Keywords: Minimally invasive; esophageal squamous cell carcinoma (ESCC); lymph node dissection; recurrent laryngeal nerve (RLN); scoring system.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Assessment of the performance of model using receiver operating characteristic (ROC) curve. The areas under ROC curve of comprehensive, age (<56 years), tumor length (>4.45 cm), tumor location and macroscopic tumor type were 0.905, 0.696, 0.736, 0.735 and 0.705, respectively.
Figure 2
Figure 2
Kaplan-Meier curves of patients in the dissection group and the control group (P value =0.255).
See this image and copyright information in PMC

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