Minimally invasive esophagectomy combined with super-extended two-field lymph node dissection for squamous cell esophageal carcinoma: Early results

Objective: To assess, the safety and early oncologic results of minimally invasive esophagectomy (MIE) combined with super-extended two-field lymph node dissection for treating esophageal squamous cell carcinoma. Methods A total of 49 patients who underwent MIE through McKeown approach (right chest, left neck, and abdomen) between May 2012 and Dec. 2013 were enrolled in this study. Lymph node dissection fields included whole mediastinum, lower para-esophagus via thoracoscope route, and abdomen. Results: The patients included 44 males and 5 females, with an age range of 45-78 years old and a median of 58 years old. Sixteen (32. 7%) patients were at Stage I. Forty-eight (98. 0%) patients received complete resection, and 18 (36. 7%) patients had post-operation complications, including 9(18. 4%) with neck leakage and 7 (14. 3%) with vocal cord paralysis. Post-operative early death occurred in one case. The mean number of removed lymph nodes was 18 and the lymph node metastasis rate was 42. 9% (21/49); 28. 6% (6/21) of the positive nodes were found in the upper mediastinum and lower para-esophagus areas. Seven of the 18 patients who were followed up had recurrence, with a recurrent rate of 38. 9%. The 7 cases included 5 in the locoregional areas and 2 in distant organs. Conclusion: MIE combined with super two-field dissection can achieve the lymphadenectomy effect recommended by National Comprehensive Cancer Network (NCCN), with satisfactory safety. Short-term follow-up indicates that the locoregional recurrence is more frequent than distant metastases, demanding more thorough mediastinal lymph node dissection.