Solitary Lymph Node Recurrence of Esophageal Squamous Cell Carcinoma: Surgical Failure or Systemic Disease?

Post-surgical solitary lymph node recurrence (SLNR) may be a characteristic of esophageal squamous cell carcinoma (ESCC). Among 402 patients who underwent curative resection for ESCC between 2003 and 2010, we retrospectively reviewed the cases of 148 patients who developed disease recurrence. Among the 148 reviewed cases, 24 patients (16.2 %) developed SLNR and 124 (83.8 %) developed non-SLNR. Clinicopathological background did not differ between the two groups. Five-year overall survival was 37.8 % among the 22 patients with SLNR who received local treatment (surgery or radiation) with or without systemic chemotherapy, compared with only 2.5 % among patients with non-SLNR (p = 0.0002). Among the 24 cases of SLNR, 18 were localized inside the surgical field (i.e. the standard three-field regional lymph nodes), while six occurred outside of the surgical field (abdominal para-aortic nodes in four cases and mediastinum in two cases). Notably, of the six patients with SLNR outside of the surgical field, four survived without additional recurrence after SLNR development. Among patients with SLNR, survival was not associated with tumor location, tumor size, or time to recurrence. Initial tumor stage was not associated with SLNR incidence but was identified as a predictor of long-term survival among patients with SLNR. SLNR developed inside and outside of the surgical field, showing a relatively favorable prognosis with local treatment regardless of location. SLNR outside of the surgical field may actually be localized disease in ESCC.