Esophagectomy combined with radical lymphadenectomy is widely accepted, but the role of three-field lymphadenectomy (3-FLD) remains unclear. Methods We performed an open-label, randomized, controlled trial involving patients with resectable cancer of the middle or lower third of the esophagus. Patients were randomly assigned to undergo esophagectomy with either 3-FLD (cervical-thoracic-abdominal lymphadenectomy) or two-field lymphadenectomy (thoracic-abdominal lymphadenectomy, 2-FLD) at a 1:1 ratio. The primary endpoint was overall survival (OS). Analysis were done according to the intent-to-treat principle. Results Postoperative complications were similar in the two arms. More lymph nodes were resected in 3-field arm (Median, 37 vs. 24 [2-FLD], P < 0.001), 43 (21.5%) patients had cervical LNM. More pN3 patients were identified in the 3-FLD arm (10.5%, 21/200 vs. 5.0%, 10/200 [2-FLD], P = 0.040). The cumulative probability of disease-free survival (DFS) was comparable between the two arms (HR, 1.021, 95%CI, 0.735–1.417, P = 0.903), as well as the OS (HR, 1.026, 95%CI, 0.694–1.515, P = 0.899). The cumulative 5-year DFS was 52% in the 3-FLD arm, as compared with 53% in the 2-FLD arm; 5-year OS rates were 64% and 62%. Conclusion Three-field lymphadenectomy offered more accurate nodal staging without increasing the surgical complications. Comparing with radical 2-FLD, there was no improvement in OS or DFS after 3-FLD for patients with middle and lower thoracic esophageal cancer. .

中文翻译：

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142 一项随机试验：三野淋巴结切除术与两野淋巴结切除术治疗胸中下段食管癌的比较

食管切除术联合根治性淋巴结清扫术已被广泛接受，但三野淋巴结清扫术（3-FLD）的作用仍不清楚。方法 我们开展了一项开放标签、随机、对照试验，涉及食管中三分之一或下三分之一的可切除癌患者。患者被随机分配接受 3-FLD（颈-胸-腹淋巴结切除术）或双野淋巴结切除术（胸-腹淋巴结切除术，2-FLD）的食管切除术，比例为 1:1。主要终点是总生存期（OS）。根据意向治疗原则进行分析。结果两组术后并发症相似。在 3 区域组中切除了更多淋巴结（中位数，37 对 24 [2-FLD]，P < 0.001），43 名（21.5%）患者患有颈部 LNM。在 3-FLD 组中发现了更多 pN3 患者（10.5%、21/200 对 5.0%、10/200 [2-FLD]，P = 0.040）。两组的无病生存期 (DFS) 累积概率 (HR, 1.021, 95%CI, 0.735–1.417, P = 0.903) 以及 OS (HR, 1.026, 95%CI, 0.694) 相当–1.515，P = 0.899）。3-FLD 组的累积 5 年 DFS 为 52%，而 2-FLD 组为 53%；5 年 OS 率为 64% 和 62%。结论 三野淋巴结清扫术在不增加手术并发症的情况下提供了更准确的淋巴结分期。与根治性 2-FLD 相比，中下段食管癌患者 3-FLD 后 OS 或 DFS 没有改善。. 95%CI, 0.735–1.417, P = 0.903)，以及 OS (HR, 1.026, 95%CI, 0.694–1.515, P = 0.899)。3-FLD 组的累积 5 年 DFS 为 52%，而 2-FLD 组为 53%；5 年 OS 率为 64% 和 62%。结论 三野淋巴结清扫术在不增加手术并发症的情况下提供了更准确的淋巴结分期。与根治性 2-FLD 相比，中下段食管癌患者 3-FLD 后 OS 或 DFS 没有改善。. 95%CI, 0.735–1.417, P = 0.903)，以及 OS (HR, 1.026, 95%CI, 0.694–1.515, P = 0.899)。3-FLD 组的累积 5 年 DFS 为 52%，而 2-FLD 组为 53%；5 年 OS 率为 64% 和 62%。结论 三野淋巴结清扫术在不增加手术并发症的情况下提供了更准确的淋巴结分期。与根治性 2-FLD 相比，中下段食管癌患者 3-FLD 后 OS 或 DFS 没有改善。. 中下段食管癌患者 3-FLD 后 OS 或 DFS 无改善。. 中下段食管癌患者 3-FLD 后 OS 或 DFS 无改善。.