Abstract OBJECTIVES This retrospective study assesses the prognostic value of subcarinal lymph node dissection (SCLND) in esophageal squamous cell carcinoma (ESCC) of the middle and lower thoracic regions. METHODS The study, conducted at the Fourth Hospital of Hebei Medical University, included 1587 patients with ESCC who underwent radical resection from 2008 to 2014, comprising 204 patients in the non-SCLND group and 1383 patients in the SCLND group. After applying inverse probability of treatment weighting (IPTW) to adjust for confounders, Kaplan–Meier curves, log-rank tests, and Cox regression were used for survival analysis, performed using R. RESULTS SCLN metastasis was found in 9.8% of patients. Factors influencing metastasis included pathologic T stage (P 0.001) and N stage (P 0.001). SCLN metastasis significantly affected overall survival, with 5-year rates of 49.0% for non-metastatic versus 7.0% for metastatic patients. SCLND improved long-term survival for T3-T4a stage patients but not for T1-T2. CONCLUSIONS Despite a low SCLN metastasis rate, its presence significantly worsens prognosis. SCLND does not significantly improve long-term survival in patients with pathologic T1-T2 tumors, but it may confer a survival benefit in T3-T4a stage disease, supporting individualized surgical decisions regarding lymph node dissection.
Xu et al. (2025) studied this question.