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Abstract：
OBJECTIVE: This research aimed to clarify the metastatic patterns of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma and to investigate appropriate strategies for lymph node dissection.
METHODS: Patients with thoracic esophageal squamous cell carcinoma receiving esophagectomy from December 2020 to April 2024 were retrospectively analyzed. Risk factors for subcarinal, right and left recurrent laryngeal nerve lymph nodes metastasis were determined by chi-square test and multivariate logistic regression analysis. We visualized the metastasis rates of these specific lymph nodes based on the different clinicopathological characteristics. Correlation between subcarinal, right and left recurrent laryngeal lymph nodes metastasis and postoperative complications were also analyzed.
RESULTS: A total of 503 thoracic esophageal squamous carcinoma patients who underwent esophagectomy were enrolled. The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes were 10.3%, 10.3%, and 10.9%, respectively. The lymphovascular invasion status and tumor location were the significant predictors for subcarinal and right recurrent laryngeal nerve lymph nodes metastasis, respectively (P < 0.001 and P = 0.013). For left recurrent laryngeal nerve lymph node metastasis, younger age (P = 0.020) and presence of lymphovascular invasion (P = 0.009) were significant risk factors. Additionally, pulmonary infection is the most frequent postoperative complication in patients with dissection of subcarinal, right and left recurrent laryngeal lymph nodes. There was no significant difference in the incidence of anastomotic leakage (P = 0.872), pulmonary infection (P = 0.139), chylothorax (P = 0.702), and hoarseness (P = 0.179) between the subcarinal lymph node dissection cohort and the reservation cohort. The incidence of hoarseness significantly increased in both right (P = 0.042) and left (P = 0.010) recurrent laryngeal nerve lymph nodes dissection cohorts compared by the reservation cohorts, with incidence rates of 5.9% and 6.7%, respectively.
CONCLUSIONS: The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma were all over 10%. The dissection of subcarinal lymph nodes does not increase postoperative complications risk, while recurrent laryngeal nerve lymph nodes dissection significantly increases the incidence of hoarseness. Thus, lymph node dissection of subcarinal lymph nodes should be conducted routinely, while recurrent laryngeal nerve lymph nodes dissection may be selectively performed in specific patients.
METHODS: Patients with thoracic esophageal squamous cell carcinoma receiving esophagectomy from December 2020 to April 2024 were retrospectively analyzed. Risk factors for subcarinal, right and left recurrent laryngeal nerve lymph nodes metastasis were determined by chi-square test and multivariate logistic regression analysis. We visualized the metastasis rates of these specific lymph nodes based on the different clinicopathological characteristics. Correlation between subcarinal, right and left recurrent laryngeal lymph nodes metastasis and postoperative complications were also analyzed.
RESULTS: A total of 503 thoracic esophageal squamous carcinoma patients who underwent esophagectomy were enrolled. The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes were 10.3%, 10.3%, and 10.9%, respectively. The lymphovascular invasion status and tumor location were the significant predictors for subcarinal and right recurrent laryngeal nerve lymph nodes metastasis, respectively (P < 0.001 and P = 0.013). For left recurrent laryngeal nerve lymph node metastasis, younger age (P = 0.020) and presence of lymphovascular invasion (P = 0.009) were significant risk factors. Additionally, pulmonary infection is the most frequent postoperative complication in patients with dissection of subcarinal, right and left recurrent laryngeal lymph nodes. There was no significant difference in the incidence of anastomotic leakage (P = 0.872), pulmonary infection (P = 0.139), chylothorax (P = 0.702), and hoarseness (P = 0.179) between the subcarinal lymph node dissection cohort and the reservation cohort. The incidence of hoarseness significantly increased in both right (P = 0.042) and left (P = 0.010) recurrent laryngeal nerve lymph nodes dissection cohorts compared by the reservation cohorts, with incidence rates of 5.9% and 6.7%, respectively.
CONCLUSIONS: The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma were all over 10%. The dissection of subcarinal lymph nodes does not increase postoperative complications risk, while recurrent laryngeal nerve lymph nodes dissection significantly increases the incidence of hoarseness. Thus, lymph node dissection of subcarinal lymph nodes should be conducted routinely, while recurrent laryngeal nerve lymph nodes dissection may be selectively performed in specific patients.
摘要：
目的：本研究旨在阐明隆突下转移模式，胸段食管鳞状细胞癌的左、右喉返神经淋巴结清扫及探讨相应的淋巴结清扫策略。
方法：对2020年12月至2024年4月行食管切除术的胸段食管鳞癌患者进行回顾性分析。隆突下的危险因素，采用卡方检验和多因素logistic回归分析确定左、右喉返神经淋巴结转移。我们根据不同的临床病理特征可视化了这些特定淋巴结的转移率。隆突下之间的相关性，同时分析左右喉返淋巴结转移及术后并发症。
结果：共纳入503例胸段食管鳞癌患者行食管切除术。隆突下的转移率，左右喉返神经淋巴结占10.3%,10.3%,10.9%，分别。淋巴管浸润状态和肿瘤位置是隆下和右喉返神经淋巴结转移的重要预测因素，分别为(P<0.001和P=0.013)。对于左喉返神经淋巴结转移，年龄较小(P=0.020)和淋巴管浸润(P=0.009)是显著的危险因素.此外,肺部感染是隆突下夹层术后最常见的并发症，左右喉返淋巴结。吻合口漏发生率差异无统计学意义(P=0.872)。肺部感染（P=0.139），乳糜胸（P=0.702），隆突下淋巴结清扫队列和保留队列之间的声音嘶哑（P=0.179）。与保留队列相比，右侧（P=0.042）和左侧（P=0.010）喉返神经淋巴结清扫队列的声音嘶哑发生率显着增加，发病率分别为5.9%和6.7%，分别。
结论：隆突下转移率，胸段食管鳞癌中左右喉返神经淋巴结均超过10%。隆突下淋巴结清扫术不会增加术后并发症风险,喉返神经淋巴结清扫术显著增加了声音嘶哑的发生率。因此，隆突下淋巴结的淋巴结清扫应常规进行，而喉返神经淋巴结清扫术可以在特定患者中选择性进行。
方法：对2020年12月至2024年4月行食管切除术的胸段食管鳞癌患者进行回顾性分析。隆突下的危险因素，采用卡方检验和多因素logistic回归分析确定左、右喉返神经淋巴结转移。我们根据不同的临床病理特征可视化了这些特定淋巴结的转移率。隆突下之间的相关性，同时分析左右喉返淋巴结转移及术后并发症。
结果：共纳入503例胸段食管鳞癌患者行食管切除术。隆突下的转移率，左右喉返神经淋巴结占10.3%,10.3%,10.9%，分别。淋巴管浸润状态和肿瘤位置是隆下和右喉返神经淋巴结转移的重要预测因素，分别为(P<0.001和P=0.013)。对于左喉返神经淋巴结转移，年龄较小(P=0.020)和淋巴管浸润(P=0.009)是显著的危险因素.此外,肺部感染是隆突下夹层术后最常见的并发症，左右喉返淋巴结。吻合口漏发生率差异无统计学意义(P=0.872)。肺部感染（P=0.139），乳糜胸（P=0.702），隆突下淋巴结清扫队列和保留队列之间的声音嘶哑（P=0.179）。与保留队列相比，右侧（P=0.042）和左侧（P=0.010）喉返神经淋巴结清扫队列的声音嘶哑发生率显着增加，发病率分别为5.9%和6.7%，分别。
结论：隆突下转移率，胸段食管鳞癌中左右喉返神经淋巴结均超过10%。隆突下淋巴结清扫术不会增加术后并发症风险,喉返神经淋巴结清扫术显著增加了声音嘶哑的发生率。因此，隆突下淋巴结的淋巴结清扫应常规进行，而喉返神经淋巴结清扫术可以在特定患者中选择性进行。
