Prognosis of Isolated Cervical Node Recurrence Following Esophagectomy With Two-Field Lymphadenectomy for Esophageal Squamous Cell Carcinoma

Three-field lymph node dissection (3FL) during esophagectomy for thoracic esophageal squamous cell carcinoma (TESCC) is controversial due to higher morbidity and uncertain survival benefits compared with 2FL. Isolated cervical/supraclavicular lymph node recurrence (ICLNR) after 2FL shows better prognosis than other recurrences. We investigated clinical features and prognosis of ICLNR following 2FL. This retrospective study analyzed patients with recurrence after upfront esophagectomy with 2FL for mid-/lower TESCC. Primary endpoint was overall survival (OS); secondary endpoint was post-recurrence survival (PRS). Among 550 patients experiencing recurrence, ICLNR occurred in 69 cases (12.5%). Patients with ICLNR demonstrated better 5-year OS than other recurrences (38.1% vs. 22.2%, P=.002). Three-year PRS was 62.5% after surgery, 61.4% after chemoradiotherapy, 38.4% after chemotherapy, 32.5% after radiotherapy. Longer disease-free interval and definitive local salvage were associated with better OS. ICLNR after 2FL showed favorable outcomes with definitive local salvage treatment. Prospective multicenter studies are needed to clarify optimal management of ICLNR.