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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2013

01-09-2013 | Thoracic Oncology

Lymph Node Harvest in Esophageal Cancer After Neoadjuvant Chemoradiotherapy

Authors: Ravi Shridhar, MD, PhD, Sarah E. Hoffe, MD, Khaldoun Almhanna, MD, MPH, Jill M. Weber, MPH, Michael D. Chuong, MD, Richard C. Karl, MD, FACS, Kenneth Meredith, MD, FACS

Published in: Annals of Surgical Oncology | Issue 9/2013

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Abstract

Background

This study was designed to determine the effects of lymph node (LN) harvest on survival in esophageal cancer after neoadjuvant chemoradiation (nCRT).

Methods

An analysis of surgically resected esophageal cancer patients after nCRT was performed to determine an association between the number of LNs resected and survival. Overall survival (OS) and disease-free survival (DFS) curves were calculated according to the Kaplan–Meier method and log-rank analysis. Multivariate analysis (MVA) was performed by the Cox proportional hazard model.

Results

We identified 358 patients with a mean follow-up of 27.3 months. The number of LN removed was not impacted by the type of surgical procedure. The number of LNs removed (<10 vs. ≥10, <12 vs. ≥12, and <15 vs. ≥15) did not impact OS or DFS. We found a significant difference in OS and DFS by pathologic response. The median and 5-year OS for patients with complete, partial, and no response was 65.6 months and 52.7 %, 29.7 months and 30.4 %, and 17.7 months and 25.4 % (p = 0.0002). However, the number of LN harvested did not impact OS and DFS when patients were stratified by pathologic response. MVA also revealed that the number of lymph nodes removed was not prognostic for OS or DFS. Higher age, higher stage, and less than a complete response were associated with a decreased OS. Higher stage and less than a complete response were prognostic for worse DFS.

Conclusions

The number of LNs harvested during esophagectomy does not impact survival after nCRT. Stage and pathologic response continue to be the strongest prognostic factors for survival in esophageal cancer after nCRT.
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Metadata
Title
Lymph Node Harvest in Esophageal Cancer After Neoadjuvant Chemoradiotherapy
Authors
Ravi Shridhar, MD, PhD
Sarah E. Hoffe, MD
Khaldoun Almhanna, MD, MPH
Jill M. Weber, MPH
Michael D. Chuong, MD
Richard C. Karl, MD, FACS
Kenneth Meredith, MD, FACS
Publication date
01-09-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 9/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-2988-4

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