Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2011

01-12-2011 | Gastrointestinal Oncology

Nodal Metastasis From Locally Advanced Esophageal Cancer: How Neoadjuvant Therapy Modifies Their Frequency and Distribution

Authors: Carlo Castoro, MD, Marco Scarpa, MD, Matteo Cagol, MD, Alberto Ruol, MD, Francesco Cavallin, MSc, Rita Alfieri, MD, Gianpietro Zanchettin, MD, Massimo Rugge, MD, Ermanno Ancona, MD

Published in: Annals of Surgical Oncology | Issue 13/2011

Login to get access

Abstract

Background

Neoadjuvant chemoradiotherapy (CT-RT) before esophagectomy seems to affect the number of nodal metastasis and to alter the distribution of those that remain. The aim of this study was to define how neoadjuvant chemoradiotherapy changes nodal metastasis patterns in locally advanced esophageal cancer.

Methods

A total of 402 consecutive patients with cancer of the esophagus or esophagogastric junction (181 adenocarcinoma [AC] and 221 squamous cell carcinoma [SCC]) (evaluated at clinical stage T1N1, T2N1, T3N0, or T3N1 and pathological stage M0) presenting in our Department between 1992 and 2007 and who underwent complete resection (R0) were included in this retrospective study on a prospectively collected database. All dissected lymph nodes were retrieved and microscopically analyzed. Nodal metastasis patterns in patients who underwent chemotherapy (CT) or chemoradiotherapy (CT-RT) neoadjuvant therapy were compared with those in patients who underwent surgery alone.

Results

Almost 30% of the adenocarcinoma patients and approximately 40% of the SCC patients showed effective tumor downstaging after neoadjuvant therapy. There were fewer paracardial node metastases (P = .002) in the AC patients who underwent CT-RT neoadjuvant therapy. There were, likewise, significantly fewer paraesophageal, paracardial, and subcarinal node metastases in the SCC patients in whom the perigastric nodes became the second-most frequent site of metastasis.

Conclusion

Not only was frequency of lymph node metastases decreased after neoadjuvant therapy, but nodal localization and pattern were also significantly modified.
Literature
1.
Peyre CG, Hagen JA, DeMeester SR, Altorki NK, Ancona E, Griffin SM, et al. The number of lymph nodes removed predicts survival in esophageal cancer: An international study on the impact of extent of surgical resection. Ann Surg. 2008;248: 549–56.PubMedCrossRef
2.
Altorki N, Skinner D. Should en bloc esophagectomy be the standard of care for esophageal carcinoma? Ann Surg. 2001;234:581–7.PubMedCrossRef
3.
Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347:1662–9.PubMedCrossRef
4.
Koenig AM, Prenzel KL, Bogoevski D, Yekebas EF, Bubenheim M, Faithova L, et al. Strong impact of micrometastatic tumor cell load in patients with esophageal carcinoma. Ann Surg Oncol. 2008;16:454–62.PubMedCrossRef
5.
Malaisrie SC, Untch B, Aranha GV, Mohideen N, Hantel A, Pickleman J. Neoadjuvant chemoradiotherapy for locally advanced esophageal cancer Experience at a single institution. Arch Surg. 2004;139:532–9.PubMedCrossRef
6.
Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J, et al. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol. 2007;8:226–34.PubMedCrossRef
7.
Mariette C, Triboulet JP. Is preoperative chemoradiation effective in treatment of oesophageal carcinoma? Lancet Oncol. 2005;6:635–7.PubMedCrossRef
8.
Mariette C, Piessen G, Lamblin A, Mirabel X, Adenis A, Triboulet JP. Impact of preoperative radiochemotherapy on postoperative course and survival in patients with locally advanced squamous cell oesophageal carcinoma. Br J Surg. 2006;93:1077–83.PubMedCrossRef
9.
Reynolds JV, Muldoon C, Hollywood D, Ravi N, Rowley S, O’Byrne K, et al. Long-term outcomes following neoadjuvant chemoradiotherapy for esophageal cancer. Ann Surg. 2007;245:707–16.PubMedCrossRef
10.
Veeramachaneni NK, Zoole JB, Decker PA, Putnam JB, Meyers BF. Lymph node analysis in esophageal resection: American College of Surgeons Oncology Group Z0060 Trial. Ann Thorac Surg. 2008;86:418–21.PubMedCrossRef
11.
Dresner SM, Lamb PJ, Bennett MK, Hayes N, Griffin SM. The pattern of metastatic lymph node dissemination from adenocarcinoma of the esophagogastric junction. Surgery. 2001;129:103–9.PubMedCrossRef
12.
Van de Ven C, De Leyn P, Coosemans W, Van Raemdonck D, Lerut T. Three-field lymphadenectomy and pattern of lymph node spread in T3 adenocarcinoma of the distal esophagus and the gastro-esophageal junction. Eur J Cardiothoracic Surg. 1999;15:769–73.PubMedCrossRef
13.
Akiyama H, Tsurumaru M, Kawamura T, Ono Y. Principles of surgical treatment for carcinoma of the esophagus: analysis of lymph node involvement. Ann Surg. 1981;194:438–46.PubMedCrossRef
14.
Akiyama H, Tsurumaru M, Udagawa H, Kajiyama J. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg. 1994;220:364–72.PubMedCrossRef
15.
Altorki N, Kent M, Ferrara C, Port J. Three-field lymph nodes dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg. 2002;236:177–83.PubMedCrossRef
16.
Lamb PJ, Griffin SM, Burt AD, Lloyd J, Karat D, Hayes N. Sentinel node biopsy to evaluate the metastatic dissemination of oesophageal adenocarcinoma. Br J Surg. 2005;92:60–7.PubMedCrossRef
17.
Burian M, Stein HJ, Sendler A, Piert M, Nahrig J, Feith M, et al. Sentinel node detection in Barrett’s and cardia cancer. Ann Surg Oncol. 2004;11:255S–8S.PubMed
18.
Grotenhuis BA, Wijnhoven BPL, van Marion R, van Dekken H, Hop WC, Tilanus HW, et al. The sentinel node concept in adenocarcinomas of the distal esophagus and gastroesophageal junction. J Thorac Cardiovasc Surg. 2009;138:608–12.PubMedCrossRef
19.
Pennathur A, Awais O, Luketich JD. Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg. 2010;89:S2159–62.PubMedCrossRef
20.
Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 2007;246:363–72; discussion 372–4.PubMedCrossRef
21.
Sobin L, Wittekind C. UICC: TNM Classification of Malignant Tumors. 6th ed. New York: Wiley, 2002.
22.
Ruol A, Portale G, Castoro C, Merigliano S, Cavallin F, Battaglia G, et al. Management of esophageal cancer in patients aged over 80 years. Eur J Cardiothorac Surg. 2007;32:445–8.PubMedCrossRef
23.
Cagol M, Ruol A, Castoro C, Alfieri R, Michieletto S, Ancona E. Prophylactic thoracic duct mass ligation prevents chylothorax after transthoracic esophagectomy for cancer. World J Surg. 2009;33:1684–6.PubMedCrossRef
24.
Holscher A, Schroder W, Bollschweiler E, Beckurts K, Schneider P. How safe is high intrathoracic esophagogastrostomy? Chirurgie. 2003;74:726–33.CrossRef
25.
Ancona E, Ruol A, Santi S, Merigliano S, Sileni VC, Koussis H, et al. Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma: final report of a randomized, controlled trial of preoperative chemotherapy versus surgery alone. Cancer. 2001;91: 2165–74.PubMedCrossRef
26.
Barbour AP, Jones M, Gonen M, Gotley DC, Thomas J, Thomson DB, et al. Refining esophageal cancer staging after neoadjuvant therapy: importance of treatment response. Ann Surg Oncol. 2008;15:2894–902.PubMedCrossRef
27.
Kelsen DP, Ginsberg R, Pajak TF, Sheahan DG, Gunderson L, Mortimer J, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med. 1998;339:1979–84.PubMedCrossRef
28.
Law S, Fok M, Chow S, Chu K, Wong J. Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg. 1997;114:210–7.PubMedCrossRef
29.
Forastiere AA, Heitmiller RF, Kleinberg L. Multimodality therapy for esophageal cancer. Chest. 1997;112(suppl):195S–200S.PubMedCrossRef
30.
Lehnert T. Multimodal therapy for squamous carcinoma of the oesophagus. Br J Surg. 1999;86:727–39.PubMedCrossRef
31.
Sutton P, Clark P. Neo-adjuvant treatment for oesophageal cancer. GI Cancer. 2000;3:231–8.
32.
Geh JI, Crellin AM, Glynne-Jones R. Preoperative (neoadjuvant) chemoradiotherapy in oesophageal cancer. Br J Surg. 2001;88:338–56.PubMedCrossRef
33.
Fumagalli U. Resective surgery for cancer of the thoracic esophagus: results of a consensus conference held at the VIth World Congress of the International Society for Diseases of the Esophagus. Dis Esophagus. 1996;9:S30–S38.
34.
Lagarde SM, Reitsma JB, ten Kate FJW, Busch ORC, Obertop H, Zwinderman AH, et al. Predicting individual survival after potentially curative esophagectomy for adenocarcinoma of the esophagus or gastroesophageal junction. Ann Surg. 2008;248:1006–13.PubMedCrossRef
35.
Kato H, Tachimori Y, Watanabe H, Iizuka T, Terui S, Itabashi M, et al. Lymph nodes metastasis in thoracic esophageal carcinoma. J Surg Oncol. 1991;48:106–11.PubMedCrossRef
Metadata
Title
Nodal Metastasis From Locally Advanced Esophageal Cancer: How Neoadjuvant Therapy Modifies Their Frequency and Distribution
Authors
Carlo Castoro, MD
Marco Scarpa, MD
Matteo Cagol, MD
Alberto Ruol, MD
Francesco Cavallin, MSc
Rita Alfieri, MD
Gianpietro Zanchettin, MD
Massimo Rugge, MD
Ermanno Ancona, MD
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 13/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1753-9

Other articles of this Issue 13/2011

Annals of Surgical Oncology 13/2011 Go to the issue

Urologic Oncology

Oncologic Outcomes and Survival in pT0 Tumors After Radical Cystectomy in Patients Without Neoadjuvant Chemotherapy: Results from a Large Multicentre Collaborative Study

Gastrointestinal Oncology

Viable Tumor Tissue Adherent to Needle Applicators after Local Ablation: A Risk Factor for Local Tumor Progression

Bone and Soft Tissue Sarcomas

Oncologic Impact of the Curettage of Grade 2 Central Chondrosarcoma of the Extremity

Hepatobiliary Tumors

Surgery Versus Intra-arterial Therapy for Neuroendocrine Liver Metastasis: A Multicenter International Analysis

Colorectal Cancer

Recurrence Rates and Prognostic Factors in ypN0 Rectal Cancer After Neoadjuvant Chemoradiation and Total Mesorectal Excision

Pancreatic Tumors

Significance of Pathologic Response to Preoperative Therapy in Pancreatic Cancer