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01-10-2020 | Metastasis

Distribution of lymph node metastases in esophageal adenocarcinoma after neoadjuvant chemoradiation therapy: a prospective study

Authors: Eliza R. C. Hagens, Hannah T. Künzli, Anne-Sophie van Rijswijk, Sybren L. Meijer, R. Clinton D. Mijnals, Bas L. A. M. Weusten, E. Debby Geijsen, Hanneke W. M. van Laarhoven, Mark I. van Berge Henegouwen, Suzanne S. Gisbertz

Published in: Surgical Endoscopy | Issue 10/2020

Abstract

Background

The distribution of lymph node metastases in esophageal adenocarcinoma following neoadjuvant chemoradiation (nCRTx) is unclear, but may have consequences for radiotherapy and surgery. The aim of this study was to define the distribution of lymph node metastases and relation to the radiation field in patients following nCRTx and esophagectomy.

Methods

Between April 2014 and August 2015 esophageal adenocarcinoma patients undergoing transthoracic esophagectomy with 2-field lymphadenectomy following nCRTx were included in this prospective observational study. Lymph node stations according to AJCC 7 were separately investigated. The location of lymph node metastases in relation to the radiation field was determined. The primary endpoint was the distribution of lymph node metastases and relation to the radiation field, the secondary endpoints were high-risk stations and risk factors for lymph node metastases and relation to survival.

Results

Fifty consecutive patients were included. Lymph node metastases were found in 60% of patients and most frequently observed in paraesophageal (28%), left gastric artery (24%), and celiac trunk (18%) stations. Fifty-two percent had lymph node metastases within the radiation field. The incidence of lymph node metastases correlated significantly with ypT-stage (p = 0.002), cT-stage (p = 0.005), lymph angioinvasion (p = 0.004), and Mandard (p = 0.002). The number of lymph node metastases was associated with survival in univariable analysis (HR 1.12, 95% CI 1.068–1.173, p < 0.001).

Conclusions

Esophageal adenocarcinoma frequently metastasizes to both the mediastinal and abdominal lymph node stations. In this study, more than half of the patients had lymph node metastases within the radiation field. nCRTx is therefore not a reason to minimize lymphadenectomy in patients with esophageal adenocarcinoma.

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Title: Distribution of lymph node metastases in esophageal adenocarcinoma after neoadjuvant chemoradiation therapy: a prospective study
Authors: Eliza R. C. Hagens
Hannah T. Künzli
Anne-Sophie van Rijswijk
Sybren L. Meijer
R. Clinton D. Mijnals
Bas L. A. M. Weusten
E. Debby Geijsen
Hanneke W. M. van Laarhoven
Mark I. van Berge Henegouwen
Suzanne S. Gisbertz
Publication date: 01-10-2020
Publisher: Springer US
Keywords: Metastasis
Esophagus Resection
Lymphadenectomy
Esophagus Resection
Published in: Surgical Endoscopy / Issue 10/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07205-y

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Distribution of lymph node metastases in esophageal adenocarcinoma after neoadjuvant chemoradiation therapy: a prospective study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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