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01-10-2017 | Original Scientific Report

Lymph Node Retrieval is Inferior in the Modified Merendino Resection for Early Barrett’s Carcinoma: A Matched-Pair Comparison with Ivor Lewis Resection

Authors: Thomas Haist, Markus Mann, Christina Oetzmann von Sochaczewski, Michael Pauthner, Annette Fisseler-Eckhoff, Dietmar Lorenz

Published in: World Journal of Surgery | Issue 10/2017

Abstract

Aim of the study

A matched-pair comparison between the modified Merendino resection (MER) and Ivor Lewis resection (ILR) for early Barrett’s carcinoma.

Background

Early adenocarcinoma of the esophagus (eACE) with positive risk factors for lymph node metastasis (LNM) needs surgery for cure. MER appeared to be an alternative to ILR.

Methods

Between July 2000 and July 2012, 156 patients with high-grade dysplasia or eACE received ILR, whereas in 30 cases MER was performed in a tertiary care center for GI Surgery. A matched-pair analysis was performed on the basis of sex, age, BMI, ASA classification and tumor stage. Thirty patients were assigned to each group. The data were analyzed regarding perioperative aspects (e.g., operating time, hospital stay, complications, number of lymph nodes) and survival analysis.

Results

The mean operating time was 301.7 min for ILR, compared to 255.4 min for MER (p = 0.044). The hospital stay following ILR was significantly longer than for MER (22.4 days ILR vs. 16.4 days MER, p = 0.023). There was no statistically significant difference regarding complications between the two groups (p = 0.463). The number of resected lymph nodes was significantly lower in the MER group (median 21) compared to the ILR group, where a median of 31 lymph nodes could be removed (p < 0.001). There was no statistically significant difference in overall (p = 0.145) or tumor-specific survival (p = 0.353).

Conclusions

Lymph node retrieval is significantly inferior in the MER. Postoperative complication rates were comparable between the two operating techniques, although the operation time for ILR took longer and these patients required a longer hospital stay. MER should not be applied in cases with high risk of LNM.

Jemal A, Murray T, Ward E et al (2005) Cancer statistics. CA Cancer J Clin 1:10–30CrossRef

Chennat J, Konda VJA, Ross AS et al (2009) Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma: an American single-center experience. Am J Gastroenterol 11:2684–2692CrossRef

Dunbar KB, Spechler SJ (2012) The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett’s esophagus: a systematic review. Am J Gastroenterol 6:850–862CrossRef

Pech O, May A, Manner H, Behrens A, Pohl J, Weferling M, Hartmann U, Manner N, Huijsmans J, Gossner L, Rabenstein T, Vieth M, Stolte M, Ell C (2014) Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 146(3):652–660. doi:10.1053/j.gastro.2013.11.006 CrossRefPubMed

Lorenz D, Origer J, Pauthner M, Graupe F, Fisseler-Eckhoff A, Stolte M, Pech O, Ell C (2014) Prognostic risk factors of early esophageal adenocarcinomas. Ann Surg 259(3):469–476CrossRefPubMed

Jamieson GG, Mathew G, Ludemann R et al (2004) Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 8:943–947CrossRef

Viklund P, Lindblad M, Lu M et al (2006) Risk factors for complications after esophageal cancer resection: a prospective population-based study in Sweden. Ann Surg 2:204–211CrossRef

Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH Jr, D’Amico TA (2004) Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 78(4):1170–1176 discussion 1170–6 CrossRefPubMed

Stein HJ, Feith M, Mueller J et al (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 6:733–742CrossRef

10.

Merendino KA, Dillard DH (1955) The concept of sphincter substitution by an interposed jejunal segment for anatomic and physiologic abnormalities at the esophagogastric junction; with special reference to reflux esophagitis, cardiospasm and esophageal varices. Ann Surg 3:486–506CrossRef

11.

Zapletal C, Heesen C, Origer J, Pauthner M, Pech O, Ell C, Lorenz D (2014) Quality of life after surgical treatment of early Barrett’s cancer: a prospective comparison of the Ivor-Lewis resection versus the modified Merendino resection. World J Surg 38(6):1444–1452. doi:10.1007/s00268-013-2410-1 CrossRefPubMed

12.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed

13.

Lerut T, Moons J, Coosemans W et al (2009) Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg 250:798–807CrossRefPubMed

14.

Tokunaga M, Kondo J, Tanizawa Y et al (2012) Postoperative intra-abdominal complications assessed by the Clavien–Dindo classification following open and laparoscopy-assisted distal gastrectomy for early gastric cancer. J Gastrointest Surg 16:1854–1859CrossRefPubMed

15.

Japan Esophageal Society (2017) Japanese Classification of Esophageal Cancer, 11th edition: part I. Esophagus 14(1):1–36CrossRef

16.

Ando S, Tsuji H (2008) Surgical technique of vagus nerve-preserving gastrectomy with D2 lymphadenectomy for gastric cancer. ANZ J Surg 3:172–176CrossRef

17.

Pech O, May A, Günter E et al (2006) The impact of endoscopic ultrasound and computed tomography on the TNM staging of early cancer in Barrett’s esophagus. Am J Gastroenterol 101:2223–2229CrossRefPubMed

18.

Pouw RE, Heldoorn N, Herrero LA et al (2011) Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases. Gastrointest Endosc 73:662–668CrossRefPubMed

19.

Pech O, Günter E, Dusemund F, Origer J, Lorenz D, Ell C (2010) Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer. Endoscopy 42(6):456–461. doi:10.1055/s-0029-1244022 Epub 2010 Mar 19 CrossRefPubMed

20.

Bergeron EJ, Lin J, Chang AC, Orringer MB, Reddy RM (2014) Endoscopic ultrasound is inadequate to determine which T1/T2 esophageal tumors are candidates for endoluminal therapies. J Thorac Cardiovasc Surg 147(2):765–771. doi:10.1016/j.jtcvs.2013.10.003 Discussion 771–3 CrossRefPubMed

21.

Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H, Ten Kate FJ, Obertop H, Tilanus HW, van Lanschot JJ (2007) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 246(6):992–1000 discussion 1000-1 CrossRefPubMed

22.

Peyer P, Christian G, Hagen JA, DeMeester SR, Altorki NK, Ancona E, Griffin SM, Hölscher A, Lerut T, Law S, Rice TW, Ruol A, van Lanschot JJB, Wong J, DeMeester TR (2008) The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg 248(4):549–556

23.

Prenzel KL, Bollschweiler E, Schröder W, Mönig SP, Drebber U, Vallboehmer D, Hölscher AH (2010) Prognostic relevance of skip metastases in esophageal cancer. Ann Thorac Surg 90(5):1662–1667. doi:10.1016/j.athoracsur.2010.07.008 CrossRefPubMed

24.

Zingg U, Smithers BM, Gotley DC, Smith G, Aly A, Clough A, Esterman AJ, Jamieson GG, Watson DI (2011) Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol 18(5):1460–1468. doi:10.1245/s10434-010-1474-5 CrossRefPubMed

25.

Li QG, Li P, Tang D, Chen J, Wang DR (2013) Impact of postoperative complications on long-term survival after radical resection for gastric cancer. World J Gastroenterol 19(25):4060–4065CrossRefPubMedPubMedCentral

26.

Bhayani NH, Gupta A, Dunst CM, Kurian AA, Reavis KM, Swanström LL (2013) Esophagectomies with thoracic incisions carry increased pulmonary morbidity. JAMA Surg 148(8):733–738. doi:10.1001/jamasurg.2013.2356 CrossRefPubMed

27.

Ferguson MK, Celauro AD, Prachand V (2011) Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg 91(5):1494–1500. doi:10.1016/j.athoracsur.2010.12.036 discussion 1500–1 CrossRefPubMed

28.

Gillinov AM, Heitmiller RF (1998) Strategies to reduce pulmonary complications after transhiatal esophagectomy. Dis Esophagus 11(1):43–47PubMed

29.

Bakhos CT, Fabian T, Oyasiji TO, Gautam S, Gangadharan SP, Kent MS, Martin J, Critchlow JF, DeCamp MM (2012) Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg 93(1):221–226. doi:10.1016/j.athoracsur.2011.07.030 discussion 226–7 CrossRefPubMed

30.

Fagundes CP, Shi Q, Vaporciyan AA, Rice DC, Popat KU, Cleeland CS, Wang XS (2015) Symptom recovery after thoracic surgery: measuring patient-reported outcomes with the MD anderson symptom inventory. J Thorac Cardiovasc Surg 150(3):613–619. doi:10.1016/j.jtcvs.2015.05.057 CrossRefPubMedPubMedCentral

Title: Lymph Node Retrieval is Inferior in the Modified Merendino Resection for Early Barrett’s Carcinoma: A Matched-Pair Comparison with Ivor Lewis Resection
Authors: Thomas Haist
Markus Mann
Christina Oetzmann von Sochaczewski
Michael Pauthner
Annette Fisseler-Eckhoff
Dietmar Lorenz
Publication date: 01-10-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 10/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4061-0

At a glance: The STEP trials

Springer Medicine

Lymph Node Retrieval is Inferior in the Modified Merendino Resection for Early Barrett’s Carcinoma: A Matched-Pair Comparison with Ivor Lewis Resection

Abstract

Aim of the study

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Aim of the study

Background

Methods

Results

Conclusions

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