The significance of subcarinal dissection in esophageal cancer surgery

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Abstract

Aim

The purpose of this study was to investigate the impact of subcarinal dissection on short-term outcome and survival following esophagectomy in patients with thoracic esophageal squamous cell carcinoma.

Methods

A total of 2252 patients underwent an esophagectomy for esophageal cancer from January 1997 to December 2008, of whom 1419 patients met the selection criteria. There were 335 cases without a subcarinal dissection and 1084 with a subcarinal dissection. Short-term outcomes and survival following the esophagectomy between the subcarinal non-dissection group and dissection group were compared.

Results

The average operation time of the subcarinal dissection group was longer than that of the non-dissection group (227 vs 208 min, P < 0.05). Both blood loss (246 vs 231 ml) and postoperative pleural drainage volume (1033 vs 950 ml) of the dissection group were significantly greater than in the non-dissection group (P < 0.05). For the entire cohort, the overall survival rate of the subcarinal non-dissection group was significantly lower than the dissection group (54 vs 36 mo., P < 0.05). However, in the N1–3 subgroup, no significant difference was found in overall survival rate between the two groups (P > 0.05). In the N0 subgroup the overall survival rate of the subcarinal non-dissection group was significantly lower than that of the dissection group (P < 0.05).

Conclusion

Subcarinal dissection is still necessary in esophagectomy for esophageal squamous cell carcinoma.

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