Surgical outcome of three-field lymph node dissection for esophageal cancer: First report in 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.