The Prognostic Significance of Subcarinal Lymph Node Dissection in Esophagectomy for Middle and Lower Thoracic Squamous Cell Carcinoma

Background This retrospective study assesses the prognostic value of subcarinal lymph node dissection (SCLND) in esophageal squamous cell carcinoma (SCC) of the middle and lower thoracic regions. Methods Conducted at the Fourth Hospital of Hebei Medical University, the study included 1588 patients with SCC who underwent radical resection from 2008 to 2014. After propensity score matching, 661 patients were analyzed, with 185 without and 476 with SCLND. Kaplan-Meier curves, Log-rank tests, and Cox regression were used for survival analysis, with SPSS 23.0. Results SCLN metastasis was found in 10.3% of patients. Factors influencing metastasis included tumor size, invasion depth, positive lymph node count, and smoking and alcohol history. SCLND significantly affected overall survival, with 5-year rates of 47.7% for non-metastatic versus 12.8% for metastatic patients. SCLND improved long-term survival for T3-T4a stage patients but not for T1-T2. Conclusion Despite a low SCLN metastasis rate, its presence significantly worsens prognosis. SCLND improves long-term survival, particularly for T3-T4a stage patients, guiding surgical decisions on lymph node dissection.