243. COMPARISON BETWEEN THE THERAPEUTIC AND PROPHYLACTIC LYMPHADENECTOMY OF THE SUPRACLAVICULAR AREA FOR PATIENTS WITH ESOPHAGEAL CANCER
Shinji Mine, Takashi Hashimoto, Hajime Orita, Motomi Nasu, Tadasuke Hashiguchi, Sanae Kaji, Daisuke Fujiwara, Yukinori Yube, Asako Ozaki, Kohei Yoshino, Yuki Sugahara, Akira Kubota, Hiroki Egawa, Tetsu Fukunaga- Gastroenterology
- General Medicine
Abstract
Backgrounds
Lymphadenectomy of the supraclavicular area (SCA) for patients with esophageal cancer has still remained controversial. Some previous studies showed that it could not improve survival. In this study, we retrospectively investigated the results of therapeutic and prophylactic lymphadenectomy around SCA for patient with esophageal cancer.
Methods
From 2010 to 2015, the patients who underwent esophagectomy with 3-fields lymphadenectomy were enrolled in this study. Patients with cervical esophageal cancer and with pN3 were excluded. Clinical nodal metastasis was decided on CT findings. Efficiency of index for lymphadenectomy (EI) was calculated with nodal incidence multiplied by 3-year relapse free survival (3yRFS).
Results
A total of 514 patients was enrolled in this study. Therapeutic lymphadenectomy was performed in 47 patients, and prophylactic lymphadenectomy was performed in 467 patients. In the therapeutic lymphadenectomy group, nodal metastasis was found in 17 patients (36.2%) and 3yRFS of these patients was 34.3%, and EI was 12.4. Meanwhile, in the prophylactic group, nodal metastasis was found in 14 (3.0%) and 3yRFS of these patients was 35.7%, and EI was 1.1. Of 514 patients, 138 received neo-adjuvant treatments. In the neo-adjuvant group, EI of the therapeutic lymphadenectomy was 21.5, and that of the prophylactic lymphadenectomy was 2.7. In the upfront surgery group, EI of the therapeutic lymphadenectomy was 0, and that of the prophylactic lymphadenectomy was 0.6.
Conclusion
The 3yRFS of the patients with pathological nodal metastasis in the SCA was relatively good. However, EI in the prophylactic group was very low due to very low incidence of the pathological nodal metastasis in the SCA. Clinical significance of prophylactic lymphadenectomy of SCA is not clear based on our data.