549. CLINICAL IMPLICATIONS OF SELECTIVE RIGHT PARATRACHEAL LYMPH NODE DISSECTION IN PATIENTS WITH EARLY-STAGE ESOPHAGEAL CANCER: PROPENSITY-SCORE MATCHED ANAYLSIS

Abstract Background The optimal extent of lymph node dissection in esophageal squamous cell carcinoma (Sqcc) still remains a topic of debate without specifying the lymph node stations. This study aimed to evaluate the clinical impact of selective right paratracheal lymph node (RtPTLN) dissection in patients with esophageal squamous cell carcinoma (SQCC). Methods We included the patients who underwent curative surgery for clinical stage I esophageal SQCC (cT1N0) at our institution between January 2010 and December 2021. Patients who underwent neoadjuvant therapy were excluded. A total of 1,484 patients underwent surgery for esophageal cancer at our institution during the study period. Among these, 658 patients (mean age 63.1±7.7 years, 46 [7.0%] women) were identified, categorized into RtPTLN+ (dissection performed, n = 88) and RtPTLN- (no dissection, n = 570) groups. The RtPTLN+/- groups were matched in a 1:3 ratio using propensity scores. Results Median follow-up was 48.8 (24.2–85.2, interquartile) months. Five-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 313 patients: RtPTLN+ (n = 83) and RtPTLN- (n = 230). OS and RFS rates did not significantly differ between RtPTLN+ and RtPTLN- groups (OS: 77.2% vs. 79.9%, P = 0.57; RFS: 72.1% vs. 74.7%, P = 0.79) after adjustment (Figure). Multivariate analysis confirmed that RtPTLN dissection was not a significant predictor for OS or RFS (Table). Conclusion In this propensity-score matched analysis, there was no significant difference in OS and RFS between patients with and without RtPTLN dissection. These findings discreetly suggest that the routine RtPTLN dissection may not be necessary, and selective dissection could be considered acceptable.