Esophagectomy With Three-Field Versus Two-Field Lymphadenectomy for Middle and Lower Thoracic Esophageal Cancer: Long-Term Outcomes of a Randomized Clinical Trial

IntroductionThe optimal extent of lymphadenectomy during esophagectomy remains unclear. In this trial, we aim to clarify whether three-field (cervical-thoracic-abdominal) improved patient survival over two-field (thoracic-abdominal) for esophageal cancer.MethodsBetween March 2013 and November 2016, a total 400 patients with middle lower thoracic cancer were included randomly assigned undergo either three- or at 1:1 ratio. Analyses done according the intention-to-treat principle. The primary end point was overall (OS), calculated from date randomization death any cause.ResultsDemographic characteristics similar in two arms. median follow-up time 55 months (95% confidence interval [CI]: 52–58). OS (hazard ratio [HR] = 1.019, 95% CI: 0.727–1.428, p 0.912) disease-free (DFS) (HR 0.868, 0.636–1.184, 0.371) comparable between cumulative 5-year 63% arm, as compared arm; DFS 59% 53%, respectively. On basis had mediastinal abdominal lymph node metastasis not, also cohort, only advanced tumor stage (pathologic TNM stages III–IV) identified risk factor associated reduced 3.330, 2.140–5.183, < 0.001).ConclusionsFor cancer, there no improvement after lymphadenectomy.