Clinical implications of selective right paratracheal lymph node dissection in patients with early-stage esophageal Cancer: Propensity score-matched analysis.

Background: This study aimed to evaluate the clinical impact of selective right paratracheal lymph node (RtPTLN) dissection in patients with esophageal squamous cell carcinoma (ESCC), focusing on oncologic outcomes.

Methods: This study included patients who underwent curative surgery for clinical stage I ESCC (cT1N0) at our institution between January 2010 and December 2021. Patients who received neoadjuvant therapy were excluded. Among 1484 patients, 658 patients (mean age 63.1 ± 7.7 years) were identified and categorized into RtPTLN+ (dissection performed, n = 88) and RtPTLN- (no dissection, n = 570) groups. The groups were propensity score matched in a 1:2 ratios.

Results: The 5-year overall survival (OS, RtPTLN + vs. RtPTLN-, 75.8 % vs. 79.0 %, P = 0.38) and recurrence-free survival (RFS, 70.0 % vs. 72.5 %, P = 0.55) rates showed no significant differences. Propensity score matching yielded 248 patients: RtPTLN+ (n = 83) and RtPTLN- (n = 162). Post-matching, OS and RFS rates did not significantly differ between RtPTLN+ and RtPTLN- groups (OS: 77.2 % vs. 77.9 %, P = 0.94; RFS: 72.1 % vs. 72.8 %, P = 0.85). Subgroup analyses based on tumor location and depth (upper-middle/lower third and T1a/T1b) yielded consistent results. Multivariable analysis confirmed that RtPTLN dissection was not a significant predictor for OS or RFS.

Conclusion: In this propensity score-matched analysis, no significant difference in OS and RFS was observed between patients who underwent RtPTLN dissection and those who did not. These findings suggest that routine RtPTLN dissection may not be necessary and that selective dissection could be an acceptable approach in early-stage ESCC.