Three-field vs two-field lymphadenectomy in thoracic ESCC patients: a multicenter randomized study (NST 1503)

Three-field vs two-field lymphadenectomy in thoracic ESCC patients: a multicenter randomized study (NST 1503)

Background: 3-field lymph node dissection (3FL) frequently lead to much more perioperative complications than 2-field lymph node dissection (2FL). This study was designed as a non-inferiority trial to evaluate whether 3FL could be omitted without compromising overall survival (OS) and disease-free s...

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Main Authors: Yousheng Mao, Shuoyan Liu, Yongtao Han, Shiping Guo, Chun Chen, Shugeng Gao, Anlin Hao, Hongbing Duan, Wentao Fang, Renquan Zhang, Zhentao Yu, Xiangning Fu, Xiaofei Li, Qun Wang, Lijie Tan, Zhigang Li, Yin Li, Zhirong Zhang, Wenqiang Wei, Yan Fang, Donghong Fu, Xudong Wei, Ligong Yuan, Shan Muhammad, Jie He
Format: Article
Language:English
Published: Elsevier 2025-04-01
Series:Journal of the National Cancer Center
Subjects:
Esophageal cancer
Lymphadenectomy
Sentinel lymph node
Surgery
Online Access:http://www.sciencedirect.com/science/article/pii/S2667005425000122
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Summary:Background: 3-field lymph node dissection (3FL) frequently lead to much more perioperative complications than 2-field lymph node dissection (2FL). This study was designed as a non-inferiority trial to evaluate whether 3FL could be omitted without compromising overall survival (OS) and disease-free survival (DFS) in the patients with resectable thoracic esophageal squamous cell cancer (ESCC) and negative right recurrent laryngeal nerve lymph nodes (RRLN-LNs). Methods: cT1b-3N0–1M0 thoracic ESCC patients were managed in 3 arms during open or minimally invasive McKeown esophagectomy according to the results of frozen section examination for RRLN-LNs: if positive, direct 3FL (RRLN[+]-3FL); if negative, 2FL (RRLN[-]-2FL) or 3FL (RRLN[-]-3FL) by randomization. Results: Based on frozen section, of the 829 finally recruited patients, 121 (13.6 %) had positive RRLN-LNs and direct 3FL (RRLN[+]-3FL); 766 had negative RRLN-LNs and were randomized into the RRLN [-]-2FL (386 cases) or RRLN[-]-3FL (380 cases) group. The cervical LN metastasis rate in the RRLN[+]-3FL group (28.9 %) was significantly higher than that in the RRLN[-]-3FL group (8.3 %) (P<0.001). The 5-year OS and DFS were 72.2 % and 65.1 % in the RRLN[-]-3FL group and 68.8 % and 62.8 % in the RRLN[-]-2FL group (OS, P = 0.163; DFS, P = 0.378), versus 50.3 % and 41.2 % in the RRLN[+]-3FL group (both P<0.001), respectively. Conclusions: Additional cervical lymphadenectomy can be avoided in the patients with middle or lower thoracic ESCC and negative RRLN-LNs by frozen section treated by upfront surgery.Trial Registration: ClinicalTrials.gov Identifier NCT02448953.
ISSN:2667-0054

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