Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis.

Abstract

Objective: This meta-analysis evaluated how the number of lymph nodes dissected (LND) and the positive lymph node ratio (LNR) following esophagectomy influence long-term outcomes in esophageal cancer.

Background: Esophagectomy is a critical treatment for esophageal cancer, but the optimal extent of lymphadenectomy remains debated, especially in the era of modern neoadjuvant protocols.

Methods: A systematic electronic search of Embase, Medline, and the Cochrane Library was performed for studies published between 2000 and 2024. Included studies assess overall survival (OS) in patients with esophageal cancer undergoing esophagectomy with lymphadenectomy, comparing groups with high and low LND and LNR. A subset analysis examined outcomes in patients receiving neoadjuvant therapy.

Results: In total, 18 and 19 articles were included in the LND and LNR meta-analyses, respectively. High LND and low LNR were associated with improved OS [LND: hazard ratio (HR) = 0.75, 95% confidence interval (CI) = 0.67-0.85, P < 0.01; LNR: HR = 0.39, 95% CI = 0.33-0.47, P < 0.001]. Subset analysis revealed that these survival benefits persisted in patients who received neoadjuvant therapy (LND: HR = 0.56, 95% CI = 0.34-0.93, P = 0.01; LNR: HR = 0.24, 95% CI = 0.15-0.39, P < 0.001).

Conclusions: These findings highlight the prognostic importance of high LND and low LNR in improving OS following esophagectomy, regardless of neoadjuvant therapy. Extensive lymphadenectomy may enhance survival, and LNR provides a valuable prognostic tool for guiding postoperative treatment decisions.