Clinical significance and outcomes of bilateral and unilateral recurrent laryngeal nerve lymph node dissection in esophageal squamous cell carcinoma: A large‐scale retrospective cohort study

• Published in: Cancer medicine (Malden, MA) Vol. 11; no. 7; pp. 1617 - 1629
• Main Authors: Zhang, Shuishen, Liu, Qianwen, Li, Bin, Jia, Minghan, Cai, Xiaoli, Yang, Weixiong, Liao, Shufen, Wu, Zhongkai, Cheng, Chao, Fu, Jianhua
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.04.2022; John Wiley and Sons Inc; Wiley
• Subjects: Aged; Cancer therapies; Clinical Cancer Research; Clinical significance; Cohort analysis; Cohort Studies; Complications; Dissection; Esophageal cancer; Esophageal Neoplasms - pathology; esophageal squamous cell carcinoma; Esophageal Squamous Cell Carcinoma - pathology; Esophageal Squamous Cell Carcinoma - surgery; Esophagus; Female; Humans; inverse probability of treatment weighting; Lymph Node Excision - adverse effects; Lymph Node Excision - methods; Lymph nodes; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis - pathology; Lymphatic system; Medical prognosis; Metastases; Metastasis; Morbidity; Ostomy; Paresis; Patients; Postoperative; Prognosis; Recurrent Laryngeal Nerve - pathology; Recurrent Laryngeal Nerve - surgery; recurrent laryngeal nerve lymph nodes dissection; Retrospective Studies; Squamous cell carcinoma; Surgeons; Thorax; Thyroid gland; Tomography; Tumors; esophageal squamous cell carcinoma; inverse probability of treatment weighting; morbidity; prognosis; recurrent laryngeal nerve lymph nodes dissection
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.4399

Background The survival benefits of recurrent laryngeal nerve lymph node dissection (RLNLD) in esophageal squamous cell carcinoma (ESCC) are still under debate, and the prognostic value of unilateral RLNLD has been rarely studied. Therefore, the aim of the present study was to investigate the clinical significance and outcomes of RLNLD in ESCC in a large‐scale cohort study, to shed light on the outcomes of unilateral RLNLD, and to identify the factors that affect the prognostic outcome of RLNLD. Methods We retrospectively reviewed 1153 patients with thoracic ESCC who underwent right thoracotomy with lymphadenectomy. The impact of RLNLD on disease‐free survival (DFS) and overall survival (OS) was estimated using the Kaplan–Meier method and Cox proportional hazard models. Inverse probability of treatment weighting (IPTW) was performed to adjust for differences in baseline variables in pairwise comparisons. Subgroup analysis of survival and postoperative complications was conducted for selective RLNLD. Results RLN lymph node (LN) metastasis was independently associated with tumor location and most other LN station metastases. RLNLD was an independent prognostic factor for DFS and OS. Both patients who underwent unilateral and bilateral RLNLD had significantly better DFS and OS than the non‐RLNLD patients. Furthermore, pairwise comparisons with IPTW confirmed these results, and we found that patients who underwent bilateral RLNLD had better survival than those who underwent unilateral RLNLD. However, subgroup analysis showed that there was no survival benefit and higher morbidity after bilateral RLNLD for patients with cancer in the lower thoracic esophagus, and elderly and female patients. Conclusion RLN LN metastasis is very frequent in ESCC, and both unilateral and bilateral RLNLD have considerable survival benefits. Selective RLNLD with better survival and lower morbidity was recommend for some defined subgroups. Unilateral as well as bilateral recurrent laryngeal nerve lymph node dissection (RLNLD) have better long‐term survival than non‐RLNLD. Selective RLNLD with better survival and less morbidity was recommend for some defined subgroups.