TY - JOUR
T1 - A Population-based Study on Lymph Node Retrieval in Patients with Esophageal Cancer
T2 - Results from the Dutch Upper Gastrointestinal Cancer Audit
AU - the Dutch Upper GI Cancer Audit group
AU - van der Werf, L. R.
AU - Dikken, J. L.
AU - van Berge Henegouwen, M. I.
AU - Lemmens, V. E.P.P.
AU - Nieuwenhuijzen, G. A.P.
AU - Wijnhoven, B. P.L.
AU - Bosscha, K.
AU - van Grieken, N. C.T.
AU - Hartgrink, H. H.
AU - van Hillegersberg, R.
AU - Lemmens, V. E.P.P.
AU - Plukker, J. T.
AU - Rosman, C.
AU - van Sandick, J. W.
AU - Siersema, P. D.
AU - Tetteroo, G.
AU - Veldhuis, P. M.J.F.
AU - Voncken, F. E.M.
N1 - Funding Information: The authors would like to thank all surgeons, registrars, physician assistants, and administrative nurses for data registration in the DUCA database. Collaborators The following members of the DUCA group were collaborators in this study: K. Bosscha (Department of Surgery, Jeroen Bosch Hospital, ?s-Hertogenbosch); N. C. T. van Grieken (Department of Pathology, VU University Medical Centre, Amsterdam); H. H. Hartgrink (Department of Surgery, Leiden University Medical Centre, Leiden); R. van Hillegersberg (Department of Surgery, University Medical Centre Utrecht, Utrecht); V. E. P. P. Lemmens (Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, IKNL); J. T. Plukker (Department of Surgery, University Medical Centre Groningen, Groningen); C. Rosman (Department of Surgery, Radboud University Medical Centre, Nijmegen); J. W. van Sandick (Department of Surgical Oncology, the Netherlands Cancer Institute?Antoni van Leeuwenhoek Hospital, Amsterdam); P.D. Siersema (Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen); G. Tetteroo (Department of Surgery, IJsselland Ziekenhuis, Capelle a/d IJssel); P. M. J. F. Veldhuis (Department of Oncological Care, IKNL); F. E. M. Voncken (Department of Radiotherapy, The Netherlands Cancer Institute?Antoni van Leeuwenhoek Hospital, Amsterdam). The authors have declared no conflicts of interest. Collaborators of the Dutch Upper Gastrointestinal Cancer group are listed in ?Acknowledgment?. Publisher Copyright: © 2018, The Author(s).
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Background: For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study is to analyze the number of retrieved LNs in The Netherlands, assess factors associated with LN yield, and explore the association with short-term outcomes. This is a population-based study on lymph node retrieval in patients with esophageal cancer, presenting results from the Dutch Upper Gastrointestinal Cancer Audit. Study Design: For this retrospective national cohort study, patients with esophageal carcinoma who underwent esophagectomy between 2011 and 2016 were included. The primary outcome was the number of retrieved LNs. Univariable and multivariable regression analyses were used to test for association with ≥ 15 LNs. Patients and Results: 3970 patients were included. Between 2011 and 2016, the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71 [0.57–0.88]), Charlson score 0 (versus: Charlson score 2: 0.76 [0.63–0.92]), cN2 category (reference: cN0, 1.32 [1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73 [1.29–2.32] and 2.15 [1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46 [1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29 [0.23–0.36] and 0.43 [0.32–0.59]), hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94 [1.55–2.42] and 3.01 [2.36–3.83]), and year of surgery [reference: 2011, odds ratios (ORs) 1.48, 1.53, 2.28, 2.44, 2.54]. There was no association of ≥ 15 LNs with short-term outcomes. Conclusions: The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN category, neoadjuvant therapy, surgical approach, year of resection, and hospital volume were all associated with increased LN yield. Retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality.
AB - Background: For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study is to analyze the number of retrieved LNs in The Netherlands, assess factors associated with LN yield, and explore the association with short-term outcomes. This is a population-based study on lymph node retrieval in patients with esophageal cancer, presenting results from the Dutch Upper Gastrointestinal Cancer Audit. Study Design: For this retrospective national cohort study, patients with esophageal carcinoma who underwent esophagectomy between 2011 and 2016 were included. The primary outcome was the number of retrieved LNs. Univariable and multivariable regression analyses were used to test for association with ≥ 15 LNs. Patients and Results: 3970 patients were included. Between 2011 and 2016, the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71 [0.57–0.88]), Charlson score 0 (versus: Charlson score 2: 0.76 [0.63–0.92]), cN2 category (reference: cN0, 1.32 [1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73 [1.29–2.32] and 2.15 [1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46 [1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29 [0.23–0.36] and 0.43 [0.32–0.59]), hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94 [1.55–2.42] and 3.01 [2.36–3.83]), and year of surgery [reference: 2011, odds ratios (ORs) 1.48, 1.53, 2.28, 2.44, 2.54]. There was no association of ≥ 15 LNs with short-term outcomes. Conclusions: The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN category, neoadjuvant therapy, surgical approach, year of resection, and hospital volume were all associated with increased LN yield. Retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality.
UR - http://www.scopus.com/inward/record.url?scp=85043379848&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85043379848&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29524046
U2 - https://doi.org/10.1245/s10434-018-6396-7
DO - https://doi.org/10.1245/s10434-018-6396-7
M3 - Article
C2 - 29524046
SN - 1068-9265
VL - 25
SP - 1211
EP - 1220
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 5
ER -