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Impact of Extent of Lymphadenectomy on Survival, Post Neoadjuvant Chemotherapy and Transthoracic Esophagectomy

Lookup NU author(s): Professor Alexander PhillipsORCiD, Dr Maziar Navidi, Professor Michael Griffin


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Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. OBJECTIVE:: The aim of this study was to evaluate the influence of lymph node yield and the location of nodes on prognosis in patients with distal esophageal or gastroesophageal junction adenocarcinoma who have received neoadjuvant chemotherapy followed by transthoracic esophagectomy. BACKGROUND:: Debate continues regarding the extent of lymphadenectomy required when carrying out an esophagectomy. Lymph node yield has been used as a surrogate for extent of lymphadenectomy. Node location must, however, be reviewed to determine the true extent of lymphadenectomy. METHODS:: Data from consecutive patients with potentially curable adenocarcinoma of the lower esophagus or gastroesophageal junction were reviewed. Patients were treated with neoadjuvant chemotherapy, transthoracic esophagectomy, and 2-field lymphadenectomy. Outcomes according to lymph node yield were determined. Projected prognosis of carrying out less radical lymphadenectomies was calculated according to 3 groups: group 1—exclusion of proximal thoracic nodes, group 2—a minimal abdominal lymphadenectomy, and group 3—a minimal abdominal and thoracic lymphadenectomy. RESULTS:: Three hundred five patients were included. Median cancer-related survival was 37.7 months (confidence interval 29–46 mo). Absolute lymph node retrieval was not related to survival (P = 0.520). An estimated additional 4 (2–6) cancer-related deaths were projected if group 1 nodes were omitted, 2 (1–4) additional deaths if group 2 nodes were omitted, and 9 (6–12) extra deaths if group 3 nodes were omitted. A minimal lymphadenectomy (groups 1, 2, and 3) was projected to lead to a 23% reduction in survival in patients with N1 or N2. CONCLUSIONS:: The present study demonstrates high lymph node yields are possible after transthoracic esophagectomy with en bloc 2-field lymphadenectomy in patients post neoadjuvant chemotherapy. This allows excellent postoperative staging. Furthermore, the extent of lymphadenectomy must be correlated with node location, which may have important implications in patients who have a less extensive lymphadenectomy.

Publication metadata

Author(s): Phillips AW, Lagarde SM, Navidi M, Disep B, Griffin SM

Publication type: Article

Publication status: Published

Journal: Annals of Surgery

Year: 2017

Volume: 265

Issue: 4

Pages: 750-756

Print publication date: 01/04/2017

Acceptance date: 02/04/2016

ISSN (print): 0003-4932

ISSN (electronic): 1528-1140

Publisher: Lippincott Williams and Wilkins


DOI: 10.1097/SLA.0000000000001737


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