Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer

Objective.The study was designed to explore the prognostic value of examined lymph node (LN) number on survival of gastric cancer patients without LN metastasis.Methods.Between August 1995 and January 2011, 300 patients who underwent gastrectomy with D2 lymphadenectomy for LN-negative gastric cancer were reviewed. Patients were assigned to various groups according to LN dissection number or tumor invasion depth. Some clinical outcomes, such as overall survival, operation time, length of stay, and postoperative complications, were compared among all groups.Results.The overall survival time of LN-negative GC patients was50.2±30.5months. Multivariate analysis indicated that LN dissection number(P<0.001)and tumor invasion depth(P<0.001)were independent prognostic factors of survival. The number of examined LNs was positively correlated with survival time(P<0.05)in patients with same tumor invasion depth but not correlated with T1 stage or examined LNs>30. Besides, it was not correlated with operation time, transfusion volume, length of postoperative stay, or postoperative complication incidence(P>0.05).Conclusions.The number of examined lymph nodes is an independent prognostic factor of survival for patients with lymph node-negative gastric cancer. Sufficient dissection of lymph nodes is recommended during surgery for such population.

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A high number of tumor free axillary lymph nodes from patients with lymph node negative breast carcinoma is associated with poor outcome

Cancer ◽

10.1002/(sici)1097-0142(20000101)88:1<108::aid-cncr15>3.0.co;2-b ◽

2000 ◽

Vol 88 (1) ◽

pp. 108-113 ◽

Cited By ~ 49

Author(s):

Robert L. Camp ◽

Eric B. Rimm ◽

David L. Rimm

Keyword(s):

Lymph Node ◽

Breast Carcinoma ◽

Lymph Nodes ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Negative ◽

Poor Outcome

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Surgical Benefits of Prone Position Thoracoscopic Esophagectomy Over Open Thoracic and Thoracoscopic Esophagectomy in Left Lateral Decubitus Position: A Literature Review

Journal of Surgical Oncology ◽

10.31487/j.jso.2020.02.02 ◽

2020 ◽

pp. 1-8

Author(s):

Kazuo Koyanagi ◽

Kentaro Yatabe ◽

Miho Yamamoto ◽

Soji Ozawa ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Postoperative Complications ◽

Lymph Nodes ◽

Mediastinal Lymph Node ◽

Minimally Invasive Esophagectomy ◽

Node Dissection ◽

Invasive Esophagectomy ◽

Left Lateral Decubitus Position ◽

Lateral Decubitus

Objective: We reviewed the surgical outcomes of minimally invasive esophagectomy (MIE), especially the number of lymph nodes retrieved, for the patients with esophageal cancer to clarify the surgical benefits of MIE in patients with esophageal cancer. Material and Methods: A systematic literature search was performed, and articles that fully described the surgical results of MIE were selected. Parameters such as operative time, blood loss, the number of lymph nodes retrieved, and postoperative complications were compared among patients undergoing minimally invasive esophagectomy (MIE) in the left lateral decubitus position (MIE-LP), MIE in the prone position (MIE-PP), and open thoracic esophagectomy (OE). Results: The conversion rate from MIE to OE was very low. MIE-PP was associated with lower blood loss than OE and MIE-LP. Results of a multicenter randomized controlled trial demonstrated that pneumonia and recurrent laryngeal nerve paralysis in MIE-PP significantly reduced compared with OE. Although postoperative complications were not different between MIE-PP and MIE-LP, the number of lymph nodes retrieved in MIE-PP was higher than that in MIE-LP. Conclusion: MIE-PP has potential benefits in terms of less surgical invasiveness and improvement of mediastinal lymph node dissection. A prospective randomized control trial using a large number of cases and long-term follow-up is recommended for analyses of appropriate mediastinal lymph node dissection and its impact on oncological benefit.

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676 NECESSITY OF EXTENDED LOWER PARATRACHEAL LYMPH NODE RESECTION DURING ESOPHAGECTOMY FOR CANCER

Diseases of the Esophagus ◽

10.1093/dote/doab052.676 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

C Mann ◽

F Berlth ◽

E Hadzijusufovic ◽

E Uzun ◽

E Tagkalos ◽

...

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Esophageal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cell Carcinoma ◽

P Value ◽

Lymph Node Resection ◽

Paratracheal Lymph Node ◽

Esophagectomy For Cancer

Abstract Objective To evaluate the impact of lower paratracheal lymph node resection on oncological radicality and complication rate during esophagectomy for cancer. Backround The ideal extend of lymphadenectomy (LAD) in esophageal surgery is debated. Until today, there has been no proof for improved survival after standardized paratracheal lymph node resection performing oncological esophagectomy. Methods Lymph nodes from the lower paratracheal station are not standardly resected during 2-field Ivor-Lewis esophagectomy for esophageal cancer. Retrospectively, we identified 200 patients operated in our center for esophageal cancer from January 2017—December 2019. Histopathologically, 143 patients suffered from adenocarcinoma, 53 patients from squamous cell carcinoma, two patients from neuroendocrine carcinoma, and one from melanoma of the esophagus. Patients with and without lower paratracheal LAD were compared to patients regarding demographic data, tumor characteristics, operative details, postoperative complications, tumor recurrence and overall survival. Results 103 of 200 patients received lower paratracheal lymph node resection. On average, six lymph nodes were resected in the paratracheal region with histopathological cancer positivity in two patients. Those two patients suffered from neuroendocrine carcinoma and melanoma, none of the AC or SCC patients were positive. There was no significant difference between both groups regarding age, gender, BMI, or comorbidity. Harvesting of lower paratracheal lymph nodes was associated with less postoperative overall complications (p-value 0,029). Regarding overall survival and recurrence rate no difference could be detected between both groups (p-value 0,168, respectively 0,371). Conclusion The resection of lower paratracheal lymph nodes during esophagectomy seems not mandatory for distal squamous cell carcinoma or adenocarcinoma of the esophagus. It may be necessary in NEC, Melanoma of the esophagus or on demand if suspicious LN are detected in the CT scan. No increase of morbidity was caused by paratracheal dissection.

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VS01.04: RELIABLE SURGICAL TECHNIQUES FOR LYMPHADENECTOMY ALONG THE LEFT RECURRENT LARYNGEAL NERVE DURING THORACOSCOPIC ESOPHAGECTOMY IN THE PRONE POSITION

Diseases of the Esophagus ◽

10.1093/dote/doy089.vs01.04 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 44-44

Author(s):

Taro Oshikiri ◽

Tetsu Nakamura ◽

Hiroshi Hasegawa ◽

Masashi Yamamoto ◽

Shingo Kanaji ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Recurrent Laryngeal Nerve ◽

Prone Position ◽

Conflicts Of Interest ◽

Surgical Techniques ◽

Laryngeal Nerve ◽

Thoracoscopic Esophagectomy ◽

Left Recurrent Laryngeal Nerve

Abstract Description Background Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control but requires advanced dissection skills. Complete dissection of the lymph nodes along the left RLN in a safe manner is important. We demonstrate the reliable method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP). Methods This procedure is performed for all of resectable thoracic esophageal cancers. The essence of this method is to recognize the lateral pedicle as a two-dimensional membrane that inclu replicatedes the left RLN, lymph nodes around the nerve, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries and distinguishing the left RLN from the lymph nodes are simplified. Results We performed 46 TEPs for esophageal cancer using this method with no conversion to an open procedure in 2015 at Kobe University. No intraoperative morbidity related to the left RLN was observed. The mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in 4 patients (8%), all of them were reversible. The incidence of lymph node metastasis along the left RLN was 22%. Conclusion Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN. Disclosure All authors have declared no conflicts of interest.

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PS02.022: INDOCYANINE GREEN: A USEFUL TOOL IN MINIMALLY INVASIVE ESOPHAGEAL CANCER SURGERY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.022 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 126-126

Author(s):

Victor Turrado-Rodriguez ◽

Dulce Nombre De Maria Momblan ◽

Ainitze Ibarzabal ◽

Alba Torroella ◽

Rafael Gerardo Diaz Del Gobo ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Indocyanine Green ◽

Esophageal Surgery ◽

Gastric Conduit ◽

Early Esophageal Cancer ◽

Regional Lymph Nodes ◽

Vascular Assessment

Abstract Background Minimally invasive approach to esophageal cancer has been accepted as the standard of care in many centers. Nontheless, some technical difficulties are encountered during surgery. A proper vascularization of the gastric tube is mandatory to avoid the dreadful complication of a leak or of gastric conduit necrosis. On the other hand, there is controversy on the identification of sentinel lymph node in early esophageal cancer and on the extent of lymphadenectomy in locally advanced tumours. Indocyanine green (ICG) is a sterile, anionic, water-soluble but relatively hydrophobic, tricarbocyanine molecule, which is bound to plasma proteins when intravenously injected. It is extracted by the liver appearing in the bile around 8 minutes after injection. When injected outside the blood vessels, ICG reaches the nearest lymph node within 15 minutes and after 1 to 2 hours it binds to the regional lymph nodes. The usual dose of ICG is 0.1 - 0.5mg/mL/kg. ICG becomes fluorescent once excited with near-infrared (NIR) light at about 820 nm. The fluorescence released by ICG may be detected using specially developed cameras. Methods A systematic review of the literature of ICG in esophageal surgery was carried on February 2018 using the following terms: esophagus, indocyanine green, ICG, surgery, angiography, lymph node, and combinations of the above. Results The technique of ICG angiography for vascular assessment of the gastroepiploic arcade and gastric conduit is explained and the published results are review. The use of ICG for the evaluation of sentinel lymph node in early esophageal cancer and of lymph node mapping for regional lymph nodes is explained and current evidence is reviewed. Conclusion ICG use in esophageal surgery is still a novel and promising technique. It could help to reduce anastomotic leak by means of vascular assessment of the gastric conduit, locate lymph nodes out of the usual fields of lymphadenectomy and locate the sentinel lymph node in early esophageal cancer Disclosure All authors have declared no conflicts of interest.

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RA09.01: NORMAL LYMPH NODE APPEARANCE IN THE THORAX

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra09.01 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 39-40

Author(s):

Tomas Hansen ◽

Magnus Nilsson ◽

Daniel Lindholm ◽

Johan Sundström ◽

Jakob Hedberg

Keyword(s):

Computed Tomography ◽

Esophageal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Conflicts Of Interest ◽

Clinical Stage ◽

Diagnostic Assessment ◽

Clinical Staging ◽

Short Axis ◽

Nodal Stage

Abstract Background Modern treatment of esophageal cancer is multimodal and highly dependent on detailed diagnostic assessment of clinical stage which includes nodal stage. Clinical appraisal of nodal stage requires knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. Methods In a sample of 426 healthy Swedish volunteers aged 50–64 years, CT scans were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. Results In the 214 men (age 57.3 ± 4.1 years) and 212 women (57.8 ± 4.4years) included in the study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) patients. Men had three times higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. Conclusion In a randomly selected cohort of patients between 50 and 64 years, almost ten percent of the men and four percent of the women had lymph nodes above ten millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above five millimeters on computed tomography and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described. Disclosure All authors have declared no conflicts of interest.

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Normal radiological lymph node appearance in the thorax

Diseases of the Esophagus ◽

10.1093/dote/doy120 ◽

2018 ◽

Vol 32 (10) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

T Hansen ◽

M Nilsson ◽

D Lindholm ◽

J Sundström ◽

J Hedberg

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Healthy Subjects ◽

Clinical Stage ◽

Diagnostic Assessment ◽

Clinical Staging ◽

Short Axis ◽

Swedish Population ◽

Nodal Stage

SUMMARY Modern treatment of esophageal cancer is multimodal and highly dependent on a detailed diagnostic assessment of clinical stage, which includes nodal stage. Clinical appraisal of nodal stage is highly dependent on knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. In a sample of the Swedish Cardiopulmonary bioimage study, which investigates a sample of the Swedish population aged 50–64 years, the CT scans of 426 subjects were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and the distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. In the 214 men (aged: 57.3 ± 4.1 years) and 212 women (aged: 57.8 ± 4.4 years) included in this study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in at least one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) of the subjects. Men had higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10 mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. We conclude that, in a randomly selected cohort of patients between 50 and 64 years, almost 10% of the men and 4% of the women had lymph nodes above 10 millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above 5 millimeters on CT and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described.

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PS01.235: THE METHOD AND THE SHORT OUTCOME OF MEDIASTINAL LYMPH NODES DISSECTION FOR ESOPHAGEAL CANCER USING A TRANS-BICERVICAL AND TRANSHIATAL APPROACH UNDER THE PNEUMOMEDIASTINUM

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.235 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 116-116

Author(s):

Yutaka Tokairin ◽

Yasuaki Nakajima ◽

Kenro Kawada ◽

Akihiro Hoshino ◽

Takuya Okada ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Recurrent Nerve ◽

Node Dissection ◽

Radical Esophagectomy ◽

Transhiatal Approach ◽

Cervical Approach ◽

Thoracic Approach ◽

The Right

Abstract Background We previously reported the performance of mediastinoscopic esophagectomy with lymph node dissection (MELD) under pneumomediastinum using a transcervical and transhiatal approach as a method of radical esophagectomy. For more complete lymph node dissection, it is necessary to dissect via not only left cervical but also right cervical approach in pneumomediastinum. We herein report the dissection method for upper mediastinum using a cervico-pneumomediastinal approach including right cervical approach in pneumomediastinum and the short surgical outcome. Methods This method was applied to nine cases for esophageal cancer. The right recurrent nerve was first identified using an open approach. Pneumomediastinum was then initiated to allow for the 105 and 106recR lymph nodes to be completely dissected along the right mediastinal pleura, the right vagus nerve, the proximal portion of the azygos vein and the right bronchial artery. The left recurrent nerve (106recL) lymph nodes and 106tbL lymph nodes were dissected using a cross-over technique, as described previously. Results This operation using bilateral cervical approach in pneumomediastinum were performed for nine cases. The median operation time and bleeding is 606 minutes and 506 ml, respectively. The median post-operative stay is 15 days. Conclusion MELD is therefore considered to be a more minimally invasive and useful modality for radical esophagectomy than the thoracic approach, although the field of view is different from that of the thoracic approach. Disclosure All authors have declared no conflicts of interest.

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