Outcomes of cervical lymph node recurrence in patients with esophageal squamous cell carcinoma after esophagectomy with 2-field lymph node dissection

Objective: The purpose of this study is to investigate the clinical characteristics, prognosis, and risk factors of patients in whom cervical lymph node cancer recurred after esophageal cancer surgery with 2-field lymph node dissection. Methods: Between 2000 and 2010, 471 consecutive patients who had undergone esophagectomy with 2-field lymph node dissection for esophageal squamous cell carcinoma were enrolled in this study. Results: Recurrence was seen in 96 patients. Isolated cervical lymph node recurrence (group A) developed in 21 patients, locoregional recurrence only and without cervical lymph node recurrence (group B) in 29, and distant recurrence with or without locoregional recurrence (group C) in 46 patients. The median times to recurrence after surgery in groups A, B, and C were 20, 16, and 12 months, respectively (P = .634). 2- and 5-year rates of isolated cervical lymph node recurrence were 4.1% and 5.6%, respectively. The median survival times from diagnosis of recurrence were 13, 7, and 5 months in groups A, B, and C, respectively. The difference in survival between groups A and C was statistically significant (P = .030). Upper thoracic esophageal cancer and positive recurrent laryngeal node at the time of initial surgery were independent risk factors for cervical recurrence-free survival as determined by univariate and multivariate analysis. Conclusions: This study shows that 2-field lymph node dissection can be performed with an acceptable rate of cervical lymph node recurrence. Patients with isolated cervical lymph node recurrence demonstrated longer survival from diagnosis of recurrence than patients with other sites of recurrence.