P1.237. Clinical Significance of Cervical Lymph Node Dissection for Esophageal Squamous Cell Carcinoma

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background The clinical significance of cervical lymph node (LN) dissection in esophageal squamous cell carcinoma (ESCC) remains uncertain. This study aimed to clarify its clinical relevance by evaluating the prognostic impact of cervical LN metastasis in patients undergoing three-field lymph node dissection (3FLND). Methods Patients with pathologically confirmed ESCC who underwent curative esophagectomy with 3FLND between 2010 and 2025 at a tertiary center in Taiwan were retrospectively reviewed. Patients were classified into cervical LN (+), non-cervical LN (+), and node-negative groups. Clinical features, tumor site, substances use, surgical complications, and survival outcomes were compared. Prognostic factors for overall survival (OS) and progression-free survival (PFS) were analyzed. Results A total of 521 patients undergoing 3FLND were included: 52 (10.0%) had cervical LN metastasis, 130 (25.0%) had non-cervical LN metastasis, and 339 (65.1%) were node-negative. Cervical LN positivity was associated with tumor site (p=0.020). No significant differences in morbidity rates (p=0.622) were observed across the three groups, including lymphatic leakage or pulmonary complications. Median OS was 13.5 months in the cervical LN (+) group (5-year OS: 9.1%) and 12.2 months in the non-cervical LN (+) group (5-year OS: 18.3%). Median PFS was 8.2 vs. 9.1 months (5-year PFS: 9.0% vs. 18.9%) in the respective groups. In multivariate analysis, pN stage independently predicted worse OS and PFS, while no significant survival difference was observed between cervical LN (+) and non-cervical LN (+) patients. Conclusion Cervical LN metastasis was not infrequent in ESCC patients and was significantly associated with tumor location. Following cervical lymph node dissection, survival outcomes were comparable between patients with cervical and non-cervical LN metastasis. Given its appreciable incidence, identifiable risk factor, acceptable morbidity, and equivalent post-dissection survival, we suggest that the role of 3FLND in ESCC be carefully reinvestigated in contemporary surgical practice.