A prospective trial for avoiding cervical lymph node dissection for thoracic esophageal cancers, based on intra-operative genetic diagnosis of micrometastasis in recurrent laryngeal nerve chain nodes

• Published in: Journal of surgical oncology Vol. 93; no. 6; pp. 477 - 484
• Main Authors: Miyata, Hiroshi, Yano, Masahiko, Doki, Yuichiro, Yasuda, Takushi, Yoshioka, Setsuko, Sugita, Yurika, Takiguchi, Shuji, Fujiwara, Yoshiyuki, Monden, Morito
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-05-2006
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Squamous Cell - genetics; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; cervical lymphadenectomy; Combined Modality Therapy; Esophageal Neoplasms - genetics; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; esophageal squamous cell carcinoma; Esophagectomy; Female; Humans; Intraoperative Period; Lymph Node Excision - methods; lymph node micrometastasis; Lymph Nodes - pathology; Lymphatic Metastasis - genetics; Lymphatic Metastasis - pathology; Male; Middle Aged; Neck; Prospective Studies; Radiotherapy, Adjuvant; real-time RT-PCR; Recurrence; Recurrent Laryngeal Nerve; Reverse Transcriptase Polymerase Chain Reaction; Survival Rate
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.20453

Background and Objectives
The aim of this study was to evaluate the usefulness of intra‐operative genetic diagnosis of RN node micrometastasis in the decision‐making of 3FL for thoracic esophageal cancers.
Methods
Eighty‐nine patients with middle and lower thoracic esophageal cancer were enrolled in a prospective study, in which 3FL was performed when RN node metastasis was revealed by intra‐operative histological examination and/or genetic analysis using real‐time RT‐PCR assay. For other cases, 2FL was performed.
Results
Of the 89 patients, 3FL was performed for 33 patients and 2FL for 56 patients. In the 3FL group, RN node metastasis was both histologically and genetically positive in 19 patients, histologically negative and genetically positive in 11, and histologically positive and genetically negative in 3, with cervical node metastasis being detected in 7, 3, and 0 patients, respectively. In the 2FL group, only one patient had cervical node recurrence during the follow‐up period. The post‐operative survival in this study was equivalent to that of the historical controls (3‐year survival rates 63.9% vs. 52.3%, P = 0.1513) of 66 3FL patients when 3FL was the first choice for thoracic esophageal cancers.
Conclusions
Intra‐operative histological and genetic diagnosis of RN node metastasis may help avoid unnecessary cervical node resection. A Phase III trial should be done. J. Surg. Oncol. 2006;93:477–484. © 2006 Wiley‐Liss, Inc.