Minimally invasive esophagectomy (MIE) has been used widely for the treatment of esophageal cancer. However, there is still a lack of consensus on the extent of lymphadenectomy in MIE. The objective of this study was to investigate the safety and efficacy of three-field lymphadenectomy (3-FL) in MIE, compared with the standard two-field lymphadenectomy (2-FL).
A single-center randomized controlled trial was conducted, enrolling patients with resectable thoracic esophageal cancer (cTNM) between June 2016 and May 2019. Eligible patients were randomized into two groups to receive either 3-FL or 2-FL during MIE procedures. Perioperative outcomes of the two groups were compared. The trial was registered in the Chinese Clinical Trial Registry, ChiCTR-INR-16007957.
Seventy-six eligible patients were randomized into the 3-FL group (n=38) and the 2-FL group (n=38). Compared with patients in the 2-FL group, patients in the 3-FL group had more lymph nodes harvested (54.7±16.5 vs. 30.9±9.6; p<0.001) and more metastatic lymph nodes identified (3.5±4.5 vs. 1.7±2.0; p=0.027). Patients in the 3-FL group were diagnosed with a more advanced final pathological TNM stage than those in the 2-FL group. There was no significant difference between the two groups in blood loss, major postoperative complications, or duration of hospital stay, except that the operation time was longer in the 3-FL group than in the 2-FL group (270.5±45.4 minutes vs. 236.7±47.0 minutes, p=0.002).
Three-field lymphadenectomy allowed harvesting of more lymph nodes and more accurate staging without increased surgical risks compared to the 2-FL in MIE for esophageal cancer.

Copyright © 2020. Published by Elsevier Inc.