• Xufeng Guo, Zhexin Wang, Hong Yang, Teng Mao, Yuping Chen, Chengchu Zhu, Zhentao Yu, Yongtao Han, Weimin Mao, Jiaqing Xiang, Zhijian Chen, Hui Liu, Haihua Yang, Jiaming Wang, Qingsong Pang, Xiao Zheng, Huanjun Yang, Tao Li, Xu Zhang, Qun Li, Geng Wang, Ting Lin, Mengzhong Liu, Jianhua Fu, and Wentao Fang.
• Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
• Ann. Surg. 2023 Feb 1; 277 (2): 259266259-266.

ObjectiveTo clarify whether systemic LND influences the safety of surgery and the survival of patients with locally advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT).Summary Of Background DataPrognostic impact of systemic lymphadenectomy during surgery after nCRT for ESCC is still uncertain and requires clarification.MethodsThis is a secondary analysis of NEOCRTEC5010 trial which compared nCRT followed by surgery versus surgery alone for locally advanced ESCC. Relationship between number of LND and perioperative, recurrence, and survival outcomes were analyzed in the nCRT group.ResultsThree-year overall survival was significantly better in the nCRT group than the S group (75.2% vs 61.5%; P = 0.011). In the nCRT group, greater number of LND was associated with significantly better overall survival (hazard ratio, 0.358; P < 0.001) and disease-free survival (hazard ratio, 0.415; P = 0.001), but without any negative impact on postoperative complications. Less LND (<20 vs ≥20) was significantly associated with increased local recurrence (18.8% vs 5.2%, P = 0.004) and total recurrence rates (41.2% vs 25.8%, P = 0.027). Compared to patients with persistent nodal disease, significantly better survival was seen in patients with complete response and with LND ≥20, but not in those with LND <20.ConclusionsSystemic LND does not increase surgical risks after nCRT in ESCC patients. And it is associated with better survival and local diseasecontrol. Therefore, systemic lymphadenectomy should still be considered as an integrated part of surgery after nCRT for ESCC.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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