Original articleGeneral thoracicComparison of the 6th and 7th Editions of the American Joint Committee on Cancer Tumor-Node-Metastasis Staging System in Patients With Resected Esophageal Carcinoma
Section snippets
Patients
The Institutional Review Board of Taipei-Veterans General Hospital approved this study and granted a waiver of the informed consent process. A total of 392 ESCC patients receiving primary surgical resection through the triincisional approach between 1995 and 2006 in Taipei-Veterans General Hospital were included in this study. The diagnosis workup and surgical procedures were as described previously [8]. In brief, all patients received preoperative studies, including physical examination,
Results
Mean follow-up time was 32.8 months (median follow-up time, 17.0 months). Overall five-year survival rate was 27.1 % with median survival of 20 months. In Table 2 the patient characteristics are summarized. The majority of patients had reconstruction with a gastric tube through the retrosternal route. The substitute organ and reconstruction route had no impact on patient survival (p = 0.113 and 0.642, respectively). Nine patients were incidentally found to have distant metastasis (lung, liver,
Comment
The 7th edition staging system strengthens the role of positive lymph nodes, by which the N classification is subdivided into N0 to N3. Therefore, a standardized extent of lymph node dissection and pathologic examination should be made in order to prevent the bias caused by inadequate lymph node evaluation. However, the evidence for routine three-field lymph node dissection is lacking. How extensive should lymph node dissection be for the thoracic esophageal cancer staging remains an important
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