TY - JOUR
T1 - Lymph node retrieval during esophagectomy with and without neoadjuvant chemoradiotherapy: prognostic and therapeutic impact on survival
AU - Koen Talsma, A.
AU - Shapiro, Joel
AU - Looman, Caspar W. N.
AU - van Hagen, Pieter
AU - Steyerberg, Ewout W.
AU - van der Gaast, Ate
AU - van Berge Henegouwen, Mark I.
AU - Wijnhoven, Bas P. L.
AU - van Lanschot, J. Jan B.
AU - Hulshof, Maarten C. C. M.
AU - van Laarhoven, Hanneke W. M.
AU - Nieuwenhuijzen, Grard A. P.
AU - Hospers, Geke A. P.
AU - Bonenkamp, Johannes J.
AU - Cuesta, Miguel A.
AU - Blaisse, Reinoud J. B.
AU - Busch, Olivier R. C.
AU - ten Kate, Fiebo J. W.
AU - Creemers, Geert-Jan
AU - Punt, Cornelis J. A.
AU - Plukker, John T. M.
AU - Verheul, Henk M. W.
AU - van Dekken, Herman
AU - van der Sangen, Maurice J. C.
AU - Rozema, Tom
AU - Biermann, Katharina
AU - Beukema, Jannet C.
AU - Piet, Anna H. M.
AU - van Rij, Caroline M.
AU - Reinders, Janny G.
AU - Tilanus, Hugo W.
AU - AUTHOR GROUP
AU - van Rij, Caroline
PY - 2014
Y1 - 2014
N2 - We aimed to examine the association between total number of resected nodes and survival in patients after esophagectomy with and without nCRT. Most studies concerning the potentially positive effect of extended lymphadenectomy on survival have been performed in patients who underwent surgery alone. As nCRT is known to frequently "sterilize" regional nodes, it is unclear whether extended lymphadenectomy after nCRT is still useful. Patients from the randomized CROSS-trial who completed the entire protocol (ie, surgery alone or chemoradiotherapy + surgery) were included. With Cox regression models, we compared the impact of number of resected nodes as well as resected positive nodes on survival in both groups. One hundred sixty-one patients underwent surgery alone, and 159 patients received multimodality treatment. The median (interquartile range) number of resected nodes was 18 (12-27) and 14 (9-21), with 2 (1-6) and 0 (0-1) resected positive nodes, respectively. Persistent lymph node positivity after nCRT had a greater negative prognostic impact on survival as compared with lymph node positivity after surgery alone. The total number of resected nodes was significantly associated with survival for patients in the surgery-alone arm (hazard ratio per 10 additionally resected nodes, 0.76; P=0.007), but not in the multimodality arm (hazard ratio 1.00; P=0.98). The number of resected nodes had a prognostic impact on survival in patients after surgery alone, but its therapeutic value is still controversial. After nCRT, the number of resected nodes was not associated with survival. These data question the indication for maximization of lymphadenectomy after nCRT
AB - We aimed to examine the association between total number of resected nodes and survival in patients after esophagectomy with and without nCRT. Most studies concerning the potentially positive effect of extended lymphadenectomy on survival have been performed in patients who underwent surgery alone. As nCRT is known to frequently "sterilize" regional nodes, it is unclear whether extended lymphadenectomy after nCRT is still useful. Patients from the randomized CROSS-trial who completed the entire protocol (ie, surgery alone or chemoradiotherapy + surgery) were included. With Cox regression models, we compared the impact of number of resected nodes as well as resected positive nodes on survival in both groups. One hundred sixty-one patients underwent surgery alone, and 159 patients received multimodality treatment. The median (interquartile range) number of resected nodes was 18 (12-27) and 14 (9-21), with 2 (1-6) and 0 (0-1) resected positive nodes, respectively. Persistent lymph node positivity after nCRT had a greater negative prognostic impact on survival as compared with lymph node positivity after surgery alone. The total number of resected nodes was significantly associated with survival for patients in the surgery-alone arm (hazard ratio per 10 additionally resected nodes, 0.76; P=0.007), but not in the multimodality arm (hazard ratio 1.00; P=0.98). The number of resected nodes had a prognostic impact on survival in patients after surgery alone, but its therapeutic value is still controversial. After nCRT, the number of resected nodes was not associated with survival. These data question the indication for maximization of lymphadenectomy after nCRT
U2 - https://doi.org/10.1097/SLA.0000000000000965
DO - https://doi.org/10.1097/SLA.0000000000000965
M3 - Article
C2 - 25379850
SN - 0003-4932
VL - 260
SP - 786-92; discussion 792-3
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -