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Multimodal Treatment for Lymph Node Recurrence of Esophageal Carcinoma After Curative Resection

Annals of Surgical Oncology volume 15, pages 2451–2457 (2008)Cite this article

Abstract

Background

Although esophagectomy with extended lymph node dissection can improve survival of patients with esophageal carcinoma, lymph node metastasis has remained one of the main recurrence patterns. The aim of this study was to evaluate the outcome of intensive treatment for recurrent lymph node metastasis.

Methods

Recurrent lymph node metastasis was detected in 68 patients with thoracic esophageal carcinoma after curative esophagectomy (R0, International Union Against Cancer criteria). Multimodal treatment was performed in 41 patients: 19 patients underwent lymphadenectomy with adjuvant therapy, and 22 received definitive chemoradiotherapy and repeated chemotherapy. The remaining 27 patients (40%) received chemotherapy or best supportive care.

Results

Survival of the lymphadenectomy and the chemoradiotherapy groups was significantly better than that of the patients who received chemotherapy or best supportive care (P < .0001). Fifteen patients (79%) underwent curative lymph node dissection (R0) in the lymphadenectomy group. Complete response, partial response, and stable disease were obtained in 8 (37%), 10 (45%), and 4 (18%) patients who received chemoradiotherapy, respectively. There was no statistically significant difference in survival between the lymphadenectomy and the chemoradiotherapy groups. Although the location of lymph node metastasis did not influence survival significantly, seven patients with nodes around the abdominal aorta did not survive longer than 3 years. The most common repeat recurrence pattern was organ metastasis after the treatment. Multivariate analysis showed that the number of metastatic nodes and tumor marker were independent prognostic factors.

Conclusion

Multimodal treatment including lymphadenectomy and chemoradiotherapy could improve survival of the patients with lymph node recurrence of esophageal carcinoma after curative resection.

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Affiliations

  1. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Tsutomu Nakamura MD, PhD, Masaho Ota MD, PhD, Kosuke Narumiya MD, PhD, Takuya Sato MD, Takeshi Ohki MD, PhD & Masakazu Yamamoto MD, PhD

  2. Department of Radiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Norio Mitsuhashi MD, PhD

Authors
  1. Tsutomu Nakamura MD, PhD
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  2. Masaho Ota MD, PhD
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  3. Kosuke Narumiya MD, PhD
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  4. Takuya Sato MD
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  5. Takeshi Ohki MD, PhD
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  6. Masakazu Yamamoto MD, PhD
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  7. Norio Mitsuhashi MD, PhD
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Corresponding author

Correspondence to Tsutomu Nakamura MD, PhD.

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Nakamura, T., Ota, M., Narumiya, K. et al. Multimodal Treatment for Lymph Node Recurrence of Esophageal Carcinoma After Curative Resection. Ann Surg Oncol 15, 2451–2457 (2008). https://doi.org/10.1245/s10434-008-0016-x

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  • DOI: https://doi.org/10.1245/s10434-008-0016-x

Key words

  • Esophageal carcinoma
  • Lymph node metastasis
  • Multimodal treatment
  • Lymphadenectomy
  • Chemoradiotherapy