Common hepatic artery
lymph node dissection is regarded as a standard procedure in
esophageal cancer surgery because of aggressive lymphatic dissemination of
esophageal cancer. However,
lymph node dissection can prolong operation time and may be associated with complications such as
chylous ascites. Here, we aimed to evaluate the effectiveness of common hepatic artery
lymph node dissection in clinical T1N0 thoracic
esophageal squamous cell carcinoma. Between 1996 and 2009, 1390 patients underwent surgery for
esophageal cancer in our institution, and 209 were found to have clinical T1N0 disease. Exclusion criteria were nonsquamous
carcinoma, double primary
cancer, definite distant
metastasis, administration of
neoadjuvant treatment, and incomplete abdominal
lymph node dissection. We retrospectively analyzed medical records, operative and pathologic data, and follow-up information. Forty-two patients were excluded from the study. Among the 167 enrolled patients, preoperative endoscopic ultrasound evaluation was performed in 160 patients. Fifty-two patients had distal esophageal or esophagogastric junction
tumor. Surgery included 2 cases of tri-incisional
esophagectomy, 17 cases of transhiatal
esophagectomy, and 148 cases of two-field
esophagectomy (Ivor Lewis operation). Common hepatic artery
lymph node dissection was performed in all cases, and none of the patients had
metastasis. Mean follow-up period was 35.4 ± 28.7 months. In-hospital mortality was one, and 5-year survival rate was 80.6%. Among the 15 patients with recurrence, there were two distant
metastases and five distant and local recurrences but no intra-abdominal recurrence with common hepatic artery lymph node. Common hepatic artery
lymph node dissection may be safely omitted in surgery for clinical T1N0
esophageal squamous cell carcinoma when preoperative evaluations including chest computed tomography, positron emission tomography and computed tomography, and esophagogastroduodenoscopy or endoscopic ultrasound are performed.