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01-11-2007

Clinical Impact of Lymphadenectomy Extent in Resectable Esophageal Cancer

Authors: Roderich E. Schwarz, David D. Smith

Published in: Journal of Gastrointestinal Surgery | Issue 11/2007

Abstract

Esophageal cancer (EC) frequently presents with advanced stages and is associated with high recurrence rates after esophagectomy. The value of an extended lymph node dissection (ELND) remains unclear in this setting. An EC data set was created from the Surveillance, Epidemiology, and End-Results 1973–2003 database. Relationships between the number of lymph nodes (LNs) examined and overall survival (OS) were analyzed. From a cohort of 40,129 EC patients, 5,620 individuals were selected. The median age was 65 (range: 11–102), and 75% were men. The median tumor size was 5.0 cm (0.1–30). On multivariate analysis, total LN count (or negative LN count, respectively) was an independent prognostic variable, aside from age, race, resection status, radiation, T category, N category (all at p < 0.0001), and M category (p = 0.0003). Higher total LN count (>30) and negative LN count (>15) categories were associated with best OS and lowest 90-day mortality (p < 0.0001). The numeric LN effect on OS was independent from nodal status or histology. Greater total and negative LN counts are associated with longer EC survival. Although the mechanism remains uncertain, it does not appear to be limited to stage migration. ELND during potentially curative esophagectomy for EC can be supported by the data.

Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005;97:142–146.PubMedCrossRef

Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin 2007;57:43–66.PubMedCrossRef

Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349:2117–2127.PubMedCrossRef

Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg 2007;245:777–783.PubMedCrossRef

Hagen JA, DeMeester SR, Peters JH, Chandrasoma P, DeMeester TR. Curative resection for esophageal adenocarcinoma: Analysis of 100 en bloc esophagectomies. Ann Surg 2001;234:520–530, discussion 530–521.PubMedCrossRef

Altorki N, Kent M, Ferrara C, Port J. Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg 2002;236:177–183.PubMedCrossRef

Portale G, Hagen JA, Peters JH, Chan LS, DeMeester SR, Gandamihardja TA, DeMeester TR. Modern 5-year survival of resectable esophageal adenocarcinoma: Single institution experience with 263 patients. J Am Coll Surg 2006;202:588–596, discussion 596–588.PubMedCrossRef

Williams VA, Peters JH. Adenocarcinoma of the gastroesophageal junction: Benefits of an extended lymphadenectomy. Surg Oncol Clin N Am 2006;15:765–780.PubMedCrossRef

Law S, Wong J. Lymph node dissection in surgical treatment of esophageal neoplasms. Surg Oncol Clin N Am 2007;16:115–131.PubMedCrossRef

10.

Dutkowski P, Hommel G, Bottger T, Schlick T, Junginger T. How many lymph nodes are needed for an accurate pN classification in esophageal cancer? Evidence for a new threshold value. Hepatogastroenterology 2002;49:176–180.PubMed

11.

Junginger T, Gockel I, Heckhoff S. A comparison of transhiatal and transthoracic resections on the prognosis in patients with squamous cell carcinoma of the esophagus. Eur J Surg Oncol 2006;32:749–755.PubMedCrossRef

12.

Rizk N, Venkatraman E, Park B, Flores R, Bains MS, Rusch V. The prognostic importance of the number of involved lymph nodes in esophageal cancer: Implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg 2006;132:1374–1381.PubMedCrossRef

13.

Nishihira T, Hirayama K, Mori S. A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 1998;175:47–51.PubMedCrossRef

14.

Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002;347:1662–1669.PubMedCrossRef

15.

Johansson J, DeMeester TR, Hagen JA, DeMeester SR, Peters JH, Oberg S, Bremner CG. En bloc vs transhiatal esophagectomy for stage T3 N1 adenocarcinoma of the distal esophagus. Arch Surg 2004;139:627–631. discussion 631–623.PubMedCrossRef

16.

D’Journo XB, Doddoli C, Michelet P, Loundou A, Trousse D, Giudicelli R, Fuentes PA, Thomas PA. Transthoracic esophagectomy for adenocarcinoma of the oesophagus: Standard versus extended two-field mediastinal lymphadenectomy? Eur J Cardiothorac Surg 2005;27:697–704.PubMedCrossRef

17.

Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: Data from a large US-population database. J Clin Oncol 2005;23:7114–7124.PubMedCrossRef

18.

Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol 2007;14:317–328.PubMedCrossRef

19.

Schwarz RE, Smith DD. Lymph node dissection impact on staging and survival of extrahepatic cholangiocarcinomas, based on U.S. population data. J Gastrointest Surg 2007;11:158–165.PubMedCrossRef

20.

Schwarz RE, Smith DD. Extent of lymph node retrieval and pancreatic cancer survival: Information from a large US population database. Ann Surg Oncol 2006;13:1189–1200.PubMedCrossRef

21.

Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M. American Joint Committee on Cancer Staging Manual, 6th ed. New York: Springer, 2002.

22.

Kang CH, Kim YT, Jeon SH, Sung SW, Kim JH. Lymphadenectomy extent is closely related to long-term survival in esophageal cancer. Eur J Cardiothorac Surg 2007;31:154–160.PubMedCrossRef

23.

Bollschweiler E, Baldus SE, Schroder W, Schneider PM, Holscher AH. Staging of esophageal carcinoma: Length of tumor and number of involved regional lymph nodes. Are these independent prognostic factors? J Surg Oncol 2006;94:355–363.PubMedCrossRef

24.

Stein HJ, Feith M, Bruecher BL, Naehrig J, Sarbia M, Siewert JR. Early esophageal cancer: Pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg 2005;242:566–573, discussion 573–565.PubMed

25.

Tsurumaru M, Kajiyama Y, Udagawa H, Akiyama H. Outcomes of extended lymph node dissection for squamous cell carcinoma of the thoracic esophagus. Ann Thorac Cardiovasc Surg 2001;7:325–329.PubMed

26.

Lerut T, Nafteux P, Moons J, Coosemans W, Decker G, De Leyn P, Van Raemdonck D, Ectors N. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: Impact on staging, disease-free survival, and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg 2004;240:962–972, discussion 972–964.PubMedCrossRef

27.

Shimada H, Okazumi S, Matsubara H, Shiratori T, Shuto K, Akutsu Y, Nabeya Y, Hayashi H, Ochiai T. Surgical outcome after the clearance of abdominal metastatic lymph nodes in 138 patients with thoracic esophageal carcinoma. Am J Surg 2007;193:448–452, discussion 453.PubMedCrossRef

28.

Waterman TA, Hagen JA, Peters JH, DeMeester SR, Taylor CR, Demeester TR. The prognostic importance of immunohistochemically detected node metastases in resected esophageal adenocarcinoma. Ann Thorac Surg 2004;78:1161–1169, discussion 1161–1169.PubMedCrossRef

29.

Heeren PA, Kelder W, Blondeel I, van Westreenen HL, Hollema H, Plukker JT. Prognostic value of nodal micrometastases in patients with cancer of the gastro-oesophageal junction. Eur J Surg Oncol 2005;31:270–276.PubMedCrossRef

30.

Schurr PG, Yekebas EF, Kaifi JT, Lasch S, Strate T, Kutup A, Cataldegirmen G, Bubenheim M, Pantel K, Izbicki JR. Lymphatic spread and microinvolvement in adenocarcinoma of the esophago-gastric junction. J Surg Oncol 2006;94:307–315.PubMedCrossRef

31.

Rizk NP, Venkatraman E, Bains MS, Park B, Flores R, Tang L, Ilson DH, Minsky BD, Rusch VW. American Joint Committee on Cancer staging system does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol 2007;25:507–512.PubMedCrossRef

32.

Wijnhoven BP, Tran KT, Esterman A, Watson DI, Tilanus HW. An evaluation of prognostic factors and tumor staging of resected carcinoma of the esophagus. Ann Surg 2007;245:717–725.PubMedCrossRef

33.

van Sandick JW, van Lanschot JJ, ten Kate FJ, Tijssen JG, Obertop H. Indicators of prognosis after transhiatal esophageal resection without thoracotomy for cancer. J Am Coll Surg 2002;194:28–36.PubMedCrossRef

34.

Eloubeidi MA, Desmond R, Arguedas MR, Reed CE, Wilcox CM. Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: The importance of tumor length and lymph node status. Cancer 2002;95:1434–1443.PubMedCrossRef

35.

Hulscher JB, Van Sandick JW, Offerhaus GJ, Tilanus HW, Obertop H, Van Lanschot JJ. Prospective analysis of the diagnostic yield of extended en bloc resection for adenocarcinoma of the oesophagus or gastric cardia. Br J Surg 2001;88:715–719.PubMedCrossRef

36.

Cense HA, van Eijck CH, Tilanus HW. New insights in the lymphatic spread of oesophageal cancer and its implications for the extent of surgical resection. Best Pract Res Clin Gastroenterol 2006;20:893–906.PubMedCrossRef

37.

Prenzel KL, Konig A, Schneider PM, Schnickmann C, Baldus SE, Schroder W, Bollschweiler E, Dienes HP, Mueller RP, Izbicki JR, Holscher AH. Reduced incidence of nodal micrometastasis after major response to neoadjuvant chemoradiation in locally advanced esophageal cancer. Ann Surg Oncol 2007;14:954–959.PubMedCrossRef

Title: Clinical Impact of Lymphadenectomy Extent in Resectable Esophageal Cancer
Authors: Roderich E. Schwarz
David D. Smith
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 11/2007
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-007-0264-2

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Clinical Impact of Lymphadenectomy Extent in Resectable Esophageal Cancer

Abstract

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