SynthesisWorld journal of surgical oncology2026
Extent of lymphadenectomy in thoracic esophageal squamous cell carcinoma: a meta-analysis of three-field versus two-field dissection.
Synthesis in World journal of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe comparative oncologic and perioperative benefits of three-field versus two-field lymphadenectomy in thoracic esophageal squamous cell carcinoma (ESCC) remain debated. This systematic review and meta-analysis evaluated outcomes across survival, nodal clearance, surgical metrics, and postoperative complications.
methodsA systematic search of PubMed, Scopus, and Web of Science was conducted up to June 15th, 2025. Comparative studies reporting outcomes of 3-field (3FL) versus 2-field (2FL) lymphadenectomy in thoracic ESCC were included. Primary outcomes were overall survival (OS), disease-free survival (DFS), recurrence, residual tumor status, and nodal/metastatic involvement. Secondary outcomes included lymph node yield, operative time, blood loss, hospital stay, complications, and mortality. Random-effects meta-analyses were performed using odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).
resultsTwenty-seven studies (28 reports) involving 10,039 patients (3FL: 3,389; 2-field: 6,504) were included. No significant differences were found in OS or DFS across all timepoints. R0 resection and recurrence rates were comparable. Three-field lymphadenectomy was associated with a higher number of dissected lymph nodes (MD = 15.01; 95% CI: 7.74-22.28), although heterogeneity was very high and small-study effects were detected. N + rates were only marginally higher with 3FL and did not reach significance (OR = 1.20; 95% CI: 0.99-1.47). Operative time, blood loss, and hospital stay were similar overall, but sensitivity analyses showed longer operative time and greater blood loss with the 3-field technique. Overall complication rates were not significantly different between groups; however, pulmonary complications (OR = 1.67; 95% CI: 1.06-2.63) and recurrent laryngeal nerve palsy (OR = 1.69; 95% CI: 1.06-2.69) were significantly higher with 3FL. Mortality rates were largely comparable, though in-hospital mortality was lower in the 3FL group (OR = 0.35; 95% CI: 0.13-0.93).
conclusionThree-field lymphadenectomy in thoracic ESCC provides superior nodal clearance but does not improve long-term survival compared to the two-field approach. It is associated with increased risk of certain complications. These findings highlight the trade-off between oncologic radicality and surgical risk, underscoring the need for individualized surgical decision-making.
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