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The necessity of recurrent laryngeal nerve lymph node resection in early-stage resectable esophageal squamous cell carcinoma : A retrospective study

anatomy-and-physiology
gastroenterology-and-hepatology
immunology
oncology
surgery-and-surgical-specialties

Abstract

Purpose: The necessity of recurrent laryngeal nerve lymph node (RLN LN) resection in early-stage, resectable esophageal squamous cell carcinoma (ESCC) remains debated. We evaluated the impact of RLN LN resection on overall survival (OS) and disease-free survival (DFS) in pT1bN0/pT2N0 thoracic ESCC, and examined whether total lymph node (LN) yield influences outcomes.
Methods: We retrospectively analyzed 212 patients with pT1bN0 or pT2N0 ESCC who underwent esophagectomy from January 2015 to September 2018. Patients were grouped by RLN LN resection (none vs ≥1 node) and by total LN yield (<15 vs ≥15, prespecified per NCCN). RLN LN procedures were further classified as sampling vs dissection. Survival was estimated by Kaplan–Meier and compared with log-rank tests; prognostic factors were assessed using Cox proportional hazards regression. Median follow-up was 62 months overall and in both RLN LN groups.
Results: RLN LN resection was associated with improved OS and DFS compared with no resection. Within the RLN LN–resected cohort, formal dissection conferred superior OS versus sampling, while DFS showed a favorable but nonsignificant trend. Bilateral resection did not improve survival compared with unilateral (right-sided) resection. Total LN yield (<15 vs ≥15) was not associated with OS or DFS in the overall cohort or within pT1b/pT2 subgroups. In multivariable analysis, RLN LN resection and tumor length were independent prognostic factors for OS, whereas RLN LN resection was the only factor significantly associated with DFS.
Conclusions: In early-stage, resectable ESCC (pT1bN0/pT2N0), RLN LN resection—particularly systematic dissection—is associated with better survival, whereas greater total LN yield does not translate into improved outcomes. Given the single-center, and retrospective design, these findings should be interpreted cautiously and validated in large, multicenter prospective studies.
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