To analyse the clinical outcomes of selective three-field lymphadenectomy for thoracic esophageal squamous carcinoma.

From June 2009 to September 2012, 127 patients with esophageal squamous cell carcinoma received selective three-field lymphadenectomy according to tumor location, invasion degree and the results of preoperative cervical ultrasonography. Of the 127 cases of esophageal squamous cell carcinoma, 49 cases of tumor located in the upper third, 67 in the middle third, and the rest 11 in the lower third. According to the TNM staging, there were 2 patients in stage Ⅰ, 26 in stage Ⅱ and 99 in stage Ⅲ.

A total of 4963 lymphatic nodes were detected, and the average number of resected lymphatic nodes was 39.3 for one case. The mean duration of operation was (325.6±9.3)min, and the mean volume of bleeding was (316.0±18.7)ml. The incidence of postoperative complications and motality were 59.8%(76/127) and 1.6%(2/127), respectively. The metastasis rate of laryngeal recurrent nerve lymph node was 40.2% (51/127), and the metastasis rate of cervical lymph node was 55.9%(71/127). In patients with middle or lower esophageal cancer, the incidence of cervical lymph node metastasis was significantly related to that of laryngeal recurrent nerve lymph node metastasis(χ²=0.005, P=0.006). The overall median survival time was (35.0±1.9) months, and the 3-year survival rate was 51.8%. The median survival time and 3-year survival rate of patients in stage Ⅱ were (42.1±3.4) months and 74.5%, respectively, those of patients in stage Ⅲ were (32.3±2.0) months and 44.8%, respectively, and there were significant differences between these two groups of patients(χ²=3.940, P=0.047). The median survival time and 3-year survival rate of cervical lymph node-positive patients were (26.2±2.1) months and 34.9%, respectively, those of cervical lymph node-negative patients were (41.5±2.3) months and 67.6%, respectively, and there were significant differences between these two groups of patients(χ²=15.283, P<0.001).

Selective three-field lymphadenectomy is a safe and feasible method which could improve the efficiency of metastatic cervical lymph node dissection, screen out potential patients who can benefit from the procedure, and prolong the survival time.