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Impact of Lymphadenectomy on Survival After Unimodality Transthoracic Esophagectomy for Adenocarcinoma of Esophagus

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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).

Results

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.

Conclusions

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.

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Acknowledgements

The authors thank Helen Jaretkze NOGU data manager for assistance in the manuscript preparation.

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Authors and Affiliations

  1. Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK

    A. W. Phillips MD, MA, FRCSEd (Gen.Surg), K. Hardy BSc, M. Navidi MB, ChB, FRCSEd (Gen.Surg), S. K. Kamarajah BMedSci, MBChB, A. Madhavan MB, ChB, MRCS, A. Immanuel MD, FRCSEd & S. M. Griffin OBE, MD, PRCSEd

  2. School of Medical Education, Newcastle University, Newcastle upon Tyne, UK

    A. W. Phillips MD, MA, FRCSEd (Gen.Surg)

  3. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK

    S. K. Kamarajah BMedSci, MBChB

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  1. A. W. Phillips MD, MA, FRCSEd (Gen.Surg)
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Correspondence to A. W. Phillips MD, MA, FRCSEd (Gen.Surg).

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Phillips, A.W., Hardy, K., Navidi, M. et al. Impact of Lymphadenectomy on Survival After Unimodality Transthoracic Esophagectomy for Adenocarcinoma of Esophagus. Ann Surg Oncol 27, 692–700 (2020). https://doi.org/10.1245/s10434-019-07905-8

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