Surgical Outcome of Three-Field Lymph Node Dissection for Esophageal Cancer: First Report in Thailand
Swangsri J, MD, PhD1, Tawantanakorn T, MD1, Parakonthun T, MD1, Methasate A, MD, PhD1
Affiliation : 1 Minimally Invasive Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Esophageal squamous cell carcinoma is one of worst prognosis cancer due to extensive lymph node metastasis and
local invasiveness. This is an initial experience in Thailand to perform esophagectomy with 3-field lymphadenectomy based on the
Japanese standard. Our objective in this study is to evaluate surgical outcome of three-field lymph node dissection in terms of
morbidity, mortality, survival and recurrent rate.
Materials and Methods : Between January 2013 and December 2019, a total of 31 patients had undergone esophagectomy with
three-field lymph node dissection at the department of surgery, Siriraj hospital Mahidol University. All of the patients had primary
squamous cell carcinoma of thoracic esophagus.
Results : None of the patients has 30-day postoperative mortality. Severe postoperative complication (Clavien-Dindo grade lllb-V)
was 12.9%. Recurrent laryngeal nerve paresis was seen in eight patients (14.8%) and this injury occurred mainly on the left side.
Metastasis lymph node rate was 54.9% which cervical node metastasis of middle and lower thoracic esophagus were 33.3% and
23.5%. Overall 3-year and 4-year survival rates were 40.0% and 24.0%, respectively. Recurrent rate was 35.4%.
Conclusion : Transthoracic esophagectomy with three-field lymph node dissection was performed in our study with no mortality
and acceptable morbidity. High metastatic rate to cervical node indicates the necessity of three-field lymph node dissection (3FL)
for thoracic esophageal carcinoma. Esophagectomy with three-field lymph node dissection should be standard procedure for
esophageal cancer in Thailand.
Keywords : Esophageal cancer, Transthoracic esophagectomy, Three-Field lymph node dissection
