Meta-Analysis
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World J Gastroenterol. Dec 21, 2014; 20(47): 18022-18030
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.18022
Three-field vs two-field lymph node dissection for esophageal cancer: A meta-analysis
Guo-Wei Ma, Dong-Rong Situ, Qi-Long Ma, Hao Long, Lan-Jun Zhang, Peng Lin, Tie-Hua Rong
Guo-Wei Ma, Dong-Rong Situ, Qi-Long Ma, Hao Long, Lan-Jun Zhang, Peng Lin, Tie-Hua Rong, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
Author contributions: Ma GW, Situ DR and Ma QL wrote and edited the manuscript and art works; Long H and Zhang LJ studied all the relevant literature and analyzed the data; Lin P and Rong TH designed the study.
Supported by Grants from the Science and Technology Planning Project of Guangdong Province, China, No. 2010B31500010, No. 2012B031800463 and No. 2013B022000040; and the National High Technology Research and Development Program of China (863 Program), No. 2009AA02Z421
Correspondence to: Tie-Hua Rong, Professor, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, No. 651 Dongfengdong Road, Guangzhou 510060, Guangdong Province, China. rongth@yeah.net
Telephone: +86-208-7343258 Fax: +86-208-7343392
Received: July 24, 2014
Revised: October 15, 2014
Accepted: December 5, 2014
Published online: December 21, 2014
Processing time: 149 Days and 3.4 Hours
Abstract

AIM: To assess the effects of 3-field lymphadenectomy for esophageal carcinoma.

METHODS: We conducted a computerized literature search of the PubMed, Cochrane Controlled Trials Register, and EMBASE databases from their inception to present. Randomized controlled trials (RCTs) or observational epidemiological studies (cohort studies) that compared the survival rates and/or postoperative complications between 2-field lymphadenectomy (2FL) and 3-field lymphadenectomy (3FL) for esophageal carcinoma with R0 resection were included. Meta-analysis was conducted using published data on 3FL vs 2FL in esophageal carcinoma patients. End points were 1-, 3-, and 5-year overall survival rates and postoperative complications, including recurrent nerve palsy, anastomosis leak, pulmonary complications, and chylothorax. Subgroup analysis was performed on the involvement of recurrent laryngeal lymph nodes.

RESULTS: Two RCTs and 18 observational studies with over 7000 patients were included. There was a clear benefit for 3FL in the 1- (RR = 1.16; 95%CI: 1.09-1.24; P < 0.01), 3- (RR = 1.44; 95%CI: 1.19-1.75; P < 0.01), and 5-year overall survival rates (RR = 1.37; 95%CI: 1.18-1.59; P < 0.01). For postoperative complications, 3FL was associated with significantly more recurrent nerve palsy (RR = 1.43; 95%CI: 1.28-1.60; P = 0.02) and anastomosis leak (RR = 1.26; 95%CI: 1.05-1.52; P = 0.09). In contrast, there was no significant difference for pulmonary complications (RR = 0.93; 95%CI: 0.75-1.16, random-effects model; P = 0.27) or chylothorax (RR = 0.77; 95%CI: 0.32-1.85; P = 0.69).

CONCLUSION: This meta-analysis shows that 3FL improves overall survival rate but has more complications. Because of the high heterogeneity among outcomes, definite conclusions are difficult to draw.

Keywords: Oesophagus; Cancer; Lymph node dissection; Survival; Complication

Core tip: Surgery for esophageal cancer includes removal of the primary lesion and lymph node dissection; however, there is a long-standing debate concerning the application of 3-field lymphadenectomy (3FL). The main purpose of the present meta-analysis was to present all available evidence in a systematic, quantitative, and unbiased fashion to establish the following 3 points: the effect of 3FL on the overall survival rate, identification of postoperative complications of 3FL compared to 2-field lymphadenectomy, and description of patient characteristics of those who will likely benefit from 3FL.