TY - JOUR
T1 - Impact of increasing lymph node yield on staging, morbidity and survival after esophagectomy for esophageal adenocarcinoma
AU - Henckens, Sofie P. G.
AU - Hagens, Eliza R. C.
AU - van Berge Henegouwen, Mark I.
AU - Meijer, Sybren L.
AU - Eshuis, Wietse J.
AU - Gisbertz, Suzanne S.
N1 - Funding Information: None of the authors declared to have competing interests. M.I.v.B.H. is consultant for Mylan, Johnson & Johnson, Alesi Surgical, BBraun and Medtronic, and received research grants from Stryker . None of these companies were involved in the design, conduct, nor analysis of this study. The remaining authors have nothing to declare. Publisher Copyright: © 2022 The Authors
PY - 2023/1
Y1 - 2023/1
N2 - Background: Extended lymphadenectomy during esophagectomy for esophageal cancer may increase survival, but also increase morbidity. This study analyses the influence of lymph node yield after transthoracic esophagectomy for esophageal adenocarcinoma on the number of positive lymph nodes, pathological N-stage, complications and survival. Materials and methods: Consecutive patients undergoing transthoracic esophagectomy for esophageal adenocarcinoma between 2010 and 2020 were prospectively recorded (follow-up until January 2022). Lymph node yield was analyzed as continuous and dichotomous variable (≤30 vs. ≥31 nodes). The effect of lymph node yield on number of positive lymph nodes, complications, disease-free (DFS) and overall survival (OS) was assessed in multivariable regression analyses. Results: 585 patients were included. Median lymph node yield increased from 25 (IQR 20–34) in 2010 to 39 (IQR 32–50) in 2020. Higher lymph node yield was associated with more positive lymph nodes (≥31 vs. ≤30 IRR 1.39, 95%CI 1.11–1.75). In 258 (y)pN + patients, the percentage of (y)pN3-stage increased with 14% between patients with ≤30 and ≥ 31 lymph nodes examined (p 0.014). Higher lymph node yield was not associated with more complications. Superior survival was seen in patients with ≥31 vs. ≤30 lymph nodes examined [DFS: HR 0.73, 95%CI 0.58–0.93, OS: HR 0.71, 95%CI 0.55–0.93)]. Conclusions: A lymph node yield of 31 or higher was associated with upstaging and superior survival after esophagectomy for esophageal adenocarcinoma, without increasing morbidity. Extended lymphadenectomy may therefore be regarded as an important part of the multimodal treatment of esophageal cancer.
AB - Background: Extended lymphadenectomy during esophagectomy for esophageal cancer may increase survival, but also increase morbidity. This study analyses the influence of lymph node yield after transthoracic esophagectomy for esophageal adenocarcinoma on the number of positive lymph nodes, pathological N-stage, complications and survival. Materials and methods: Consecutive patients undergoing transthoracic esophagectomy for esophageal adenocarcinoma between 2010 and 2020 were prospectively recorded (follow-up until January 2022). Lymph node yield was analyzed as continuous and dichotomous variable (≤30 vs. ≥31 nodes). The effect of lymph node yield on number of positive lymph nodes, complications, disease-free (DFS) and overall survival (OS) was assessed in multivariable regression analyses. Results: 585 patients were included. Median lymph node yield increased from 25 (IQR 20–34) in 2010 to 39 (IQR 32–50) in 2020. Higher lymph node yield was associated with more positive lymph nodes (≥31 vs. ≤30 IRR 1.39, 95%CI 1.11–1.75). In 258 (y)pN + patients, the percentage of (y)pN3-stage increased with 14% between patients with ≤30 and ≥ 31 lymph nodes examined (p 0.014). Higher lymph node yield was not associated with more complications. Superior survival was seen in patients with ≥31 vs. ≤30 lymph nodes examined [DFS: HR 0.73, 95%CI 0.58–0.93, OS: HR 0.71, 95%CI 0.55–0.93)]. Conclusions: A lymph node yield of 31 or higher was associated with upstaging and superior survival after esophagectomy for esophageal adenocarcinoma, without increasing morbidity. Extended lymphadenectomy may therefore be regarded as an important part of the multimodal treatment of esophageal cancer.
KW - Complications
KW - Esophagectomy
KW - Lymph node yield
KW - Lymphadenectomy
KW - Staging
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85135527736&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2022.07.012
DO - https://doi.org/10.1016/j.ejso.2022.07.012
M3 - Article
C2 - 35933270
SN - 0748-7983
VL - 49
SP - 89
EP - 96
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 1
ER -