Impact of Lymphadenectomy on Survival After Unimodality Transthoracic Esophagectomy for Adenocarcinoma of Esophagus
Debate remains regarding the extent of lymphadenectomy required with esophagectomy. In patients who receive neoadjuvant treatment, this may address lymph node metastases. However, patients with early disease and those with comorbidities may not receive neoadjuvant treatment. The aim of this study is to determine the impact of lymph node yield and location on prognosis in patients undergoing esophagectomy without neoadjuvant treatment.
Patients and Methods
Data from consecutive patients with potentially curable adenocarcinoma of the esophagus or gastroesophageal junction were reviewed. Patients were treated with transthoracic esophagectomy and two-field lymphadenectomy. Outcomes according to lymph node yield were determined. The prognosis of carrying out less radical lymphadenectomy was calculated according to three groups: exclusion of proximal thoracic nodes (group 1), minimal abdominal lymphadenectomy (group 2), and minimal abdominal and thoracic lymphadenectomy (group 3).
357 patients were included. Median survival was 78 months [confidence interval (CI) 53–103 months]. Absolute lymph node retrieval was not related to survival (p = 0.920). An estimated additional 4 (2–6) cancer-related deaths was projected if group 1 nodes were omitted, 15 (11–19) additional deaths if group 2 nodes were omitted, and 4 (2–6) deaths if group 3 nodes were omitted. Minimal lymphadenectomy (groups 1, 2, and 3) was projected to lead to 19 (15–23) additional cancer-related deaths.
Extensive lymphadenectomy allows accurate staging. In patients who do not receive neoadjuvant treatment, it may confer a survival benefit. The number of lymph nodes retrieved may not be a good surrogate for extent of lymphadenectomy, and correlation with location is required.
The authors thank Helen Jaretkze NOGU data manager for assistance in the manuscript preparation.
The authors declare that no support or grants were received for this work and no conflict of interest.
- 4.Visser E, Markar SR, Ruurda JP, Hanna GB, van Hillegersberg R. Prognostic value of lymph node yield on overall survival in esophageal cancer patients. Ann Surg. 2018;1.Google Scholar
- 16.Talsma AK, Xinxue CJO, Pieter L, Wijnhoven BPL, Ong C-AJ, Liu X, et al. Location of lymph node involvement in patients with esophageal adenocarcinoma predicts survival. World J Surg. 2014;38(1):106–13.Google Scholar
- 19.Sobin LH. TNM classification of malignant tumours. 7th ed. New York: Wiley; 2009.Google Scholar
- 22.Mapstone N. Dataset for the histopahtological reporting of oesophageal carcinoma. 2nd ed. 2007.Google Scholar
- 23.Schaaf MVD, Johar A, Wijnhoven B, Lagergren P, Lagergren J, van der Schaaf M, et al. Extent of lymph node removal during esophageal cancer surgery and survival. JNCI J Natl Cancer Inst. 2015; 107(5):djv043–djv043.Google Scholar
- 24.Lagergren J, Mattsson F, Zylstra J, Chang F, Gossage J, Mason R, et al. Extent of lymphadenectomy and prognosis after esophageal cancer surgery. JAMA Surg. 2015;1–8.Google Scholar
- 25.Veloski J, Boex JR, Grasberger MJ, Evans A, Wolfson DB. Systematic review of the literature on assessment, feedback and physicians’ clinical performance: BEME Guide No. 7. Med Teach. 2006;28(2):117–28.Google Scholar
- 27.Rice TW, Gress DM, Patil DT, Hofstetter WL, Kelsen DP, Blackstone EH. Cancer of the esophagus and esophagogastric junction-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(4): 304–17. https://doi.org/10.3322/caac.21399.CrossRefPubMedGoogle Scholar