Resection of the irradiated esophagus: the impact of lymph node yield on survival

SUMMARY There is debate surrounding the appropriate threshold for lymph node harvest during esophagectomy in patients with esophageal cancer, specifically for those receiving preoperative radiation. The purpose of this study was to determine the impact of lymph node yield on survival in patients receiving preoperative chemoradiation for esophageal cancer. The National Cancer Database (NCDB) was utilized to identify patients with esophageal cancer that received preoperative radiation. The cohort was divided into patients undergoing minimal (<9) or extensive (≥9) lymph node yield. Demographic, operative, and postoperative outcomes were compared between the groups. Kaplan–Meier analysis with the log rank test was used to compare survival between the yield groups. Cox proportional hazards model was used to determine the association between lymph node yield and survival. In total, 886 cases were included: 349 (39%) belonging to the minimal node group and 537 (61%) to the extensive group. Unadjusted 5-year survival was similar between the minimal and extensive groups, respectively (37.3% vs. 38.8%; P > 0.05). After adjustment using Cox regression, extensive lymph node yield was associated with survival (hazard ratio 0.80, confidence interval 0.66–0.98, P = 0.03). This study suggests that extensive lymph node yield is advantageous for patients with esophageal cancer undergoing esophagectomy following induction therapy. This most likely reflects improved diagnosis and staging with extensive yield.

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P101 THE IMPACT OF PARATRACHEAL LYMPHADENECTOMY ON LYMPH NODE YIELD AND SHORT-TERM OUTCOMES IN ESOPHAGECTOMY: A NATIONAL PROPENSITY SCORE MATCHED ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doz092.101 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

B F Kingma ◽

E R C Hagens ◽

M I van Berge Henegouwen ◽

A S Borggreve ◽

J P Ruurda ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Transthoracic Esophagectomy ◽

Short Term ◽

Lymph Node Yield ◽

Ivor Lewis ◽

Esophagectomy For Cancer ◽

Mckeown Esophagectomy ◽

The Impact ◽

Node Yield

Abstract Aim This study aimed to investigate the impact of paratracheal lymphadenectomy on lymph node yield and short-term outcomes in patients undergoing esophagectomy for cancer. Background & Methods Although the addition of paratracheal lymphadenectomy to a standard two-field lymphadenectomy possibly may provide survival benefits for patients undergoing esophagectomy for esophageal cancer, the required dissection along the recurrent laryngeal nerves might be associated with increased morbidity. To investigate the impact of paratracheal lymphadenectomy on short-term oncological outcomes and postoperative complications, this nation-wide population-based cohort study included esophageal cancer patients who underwent neoadjuvant chemoradiotherapy followed by elective transthoracic esophagectomy with at least subcarinal and para-esophageal lymphadenectomy from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). After propensity score matching Ivor Lewis and McKeown approaches separately, the lymph node yield and clinical outcomes were compared between patients who underwent paratracheal lymphadenectomy versus patients who did not. Results Between 2011-2017, a total of 2128 patients were included. A total of 770 patients (n=385 vs. n=385) and 516 patients (n=258 vs. n=258) were matched for the Ivor Lewis and McKeown approaches, respectively. Paratracheal lymphadenectomy was associated with a higher total lymph node yield in both Ivor Lewis (23 vs. 19 nodes, P<0.001) and McKeown (21 vs. 19 nodes, P=0.015) esophagectomy. In McKeown esophagectomy, paratracheal lymphadenectomy was associated with significantly more advanced pathological nodal staging (pN0; 57% vs. 69%, pN1; 25% vs. 16%, pN2; 12% vs. 11%, pN3; 6% vs. 3%, P=0.006). No significant differences were observed regarding recurrent laryngeal nerve injury, other postoperative complications, and mortality, although a higher re-intervention rate was found after paratracheal lymphadenectomy during McKeown esophagectomy (30% vs. 18%, P=0.002) In patients undergoing Ivor Lewis esophagectomy, paratracheal lymphadenectomy was associated with increased length of stay (12 vs. 11 days, P<0.048). Conclusion In patients undergoing transthoracic esophagectomy for cancer, the addition of paratracheal lymphadenectomy results in a higher lymph node yield with comparable complication and mortality rates.

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Fat clearance of upper gastrointestinal resection specimens increases lymph node yield and may result in nodal upstaging

Journal of Clinical Pathology ◽

10.1136/jclinpath-2018-205457 ◽

2018 ◽

Vol 72 (1) ◽

pp. 86-89

Author(s):

Jon Griffin ◽

Clare Bunning ◽

Asha Dubé

Keyword(s):

Lymph Node ◽

Gastrointestinal Cancers ◽

Historical Cohort ◽

Lymph Node Yield ◽

Patient Demographics ◽

Lymph Node Retrieval ◽

Nodal Upstaging ◽

The Impact ◽

Upper Gastrointestinal ◽

Node Yield

IntroductionLymph node retrieval and quantification is an important element in staging upper gastrointestinal cancers. Our department introduced fat clearance for oesophagectomy and gastrectomy specimens in 2014. This study assessed the impact of this change on lymph node yield and upstaging.MethodsWe reviewed histopathology data for upper gastrointestinal resection specimens. Patient demographics, clinical, macroscopic and microscopic data were compared with a historical cohort who did not undergo fat clearance.ResultsOf 158 patients, 133 resection specimens received fat clearance resulting in a significantly higher lymph node yield than the historical cohort (22 vs 13 lymph nodes, p<0.0001). Fat clearance found additional positive nodes in 24.1% of patients and increased the number of cases achieving a minimum node yield of 15. Nodes found by fat clearance caused upstaging in 15% of the cohort.DiscussionFat clearance increases node yield in upper gastrointestinal resection specimens and may cause nodal upstaging.

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Impact of Lymph Node Yield in Patients Undergoing Total Laryngectomy and Neck Dissection

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420964824 ◽

2020 ◽

pp. 000348942096482

Author(s):

Michael C. Topf ◽

Ramez Philips ◽

Joseph Curry ◽

Linda C. Magana ◽

Madalina Tuluc ◽

...

Keyword(s):

Radiation Therapy ◽

Lymph Node ◽

Neck Dissection ◽

Total Laryngectomy ◽

Single Institution ◽

Level Of Evidence ◽

Lymph Node Yield ◽

Positive Margins ◽

The Impact ◽

Node Yield

Objectives: To determine the impact of lymph node yield (LNY) in patients undergoing neck dissection at the time of total laryngectomy (TL). To determine the impact of radiation therapy (RT) on LNY. Methods: Retrospective review of LNY and clinical outcomes in 232 patients undergoing primary or salvage total laryngectomy (TL) with ND. Results: Preoperative RT significantly decreased mean LNY from 31.7 to 23.9 nodes ( P < .001). In primary TL patients, age ( P < .001) and positive margins ( P = .044) were associated with decreased OS. In salvage TL patients, only positive margins was associated with poorer OS ( P = .009). No LNY cutoff provided significant OS or DFS benefit. Conclusions: Radiotherapy significantly reduces LNY in patients undergoing TL and ND. Within a single institution cohort, positive margins, but not LNY, is associated with survival in both primary and salvage TL patients. Level of Evidence: 4

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The Potential of Lymph Node Yield as a Quality Indicator of Esophagectomy for Esophageal Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-020-09146-6 ◽

2020 ◽

Vol 28 (1) ◽

pp. 9-10

Author(s):

Satoru Matsuda ◽

Yuko Kitagawa

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Quality Indicator ◽

Lymph Node Yield ◽

Node Yield

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Is More Always Better? An Assessment of the Impact of Lymph Node Yield on Outcome for Clinically Localized Prostate Cancer with Low/Intermediate Risk Pathology (pT2-3a/pN0) Managed with Prostatectomy Alone

Pathology & Oncology Research ◽

10.1007/s12253-017-0349-5 ◽

2017 ◽

Vol 25 (1) ◽

pp. 209-215 ◽

Cited By ~ 1

Author(s):

Steven N. Seyedin ◽

Darrion L. Mitchell ◽

Sarah L. Mott ◽

J. Kyle Russo ◽

Chad R. Tracy ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Localized Prostate Cancer ◽

Intermediate Risk ◽

Lymph Node Yield ◽

The Impact ◽

Node Yield

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Cohort Study of the Impact of Time to Antibiotic Administration on Mortality in Patients with Febrile Neutropenia

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02561-14 ◽

2014 ◽

Vol 58 (7) ◽

pp. 3799-3803 ◽

Cited By ~ 64

Author(s):

Regis G. Rosa ◽

Luciano Z. Goldani

Keyword(s):

Cohort Study ◽

Febrile Neutropenia ◽

Cancer Patients ◽

Cox Regression ◽

Mortality Rates ◽

Cox Proportional Hazards Model ◽

Rank Test ◽

Antibiotic Administration ◽

Cox Regression Analysis ◽

The Impact

ABSTRACTThe time to antibiotic administration (TTA) has been proposed as a quality-of-care measure in febrile neutropenia (FN); however, few data regarding the impact of the TTA on the mortality of adult cancer patients with FN are available. The objective of this study was to determine whether the TTA is a predictor of mortality in adult cancer patients with FN. A prospective cohort study of all consecutive cases of FN, evaluated from October 2009 to August 2011, at a single tertiary referral hospital in southern Brazil was performed. The TTA was assessed as a predictive factor for mortality within 28 days of FN onset using the Cox proportional hazards model. Kaplan-Meier curves were used for an assessment of the mortality rates according to different TTAs; the log-rank test was used for between-group comparisons. In total, 307 cases of FN (169 subjects) were evaluated. During the study period, there were 29 deaths. In a Cox regression analysis, the TTA was independently associated with mortality within 28 days (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.10 to 1.26); each increase of 1 h in the TTA raised the risk of mortality within 28 days by 18%. Patients with FN episodes with a TTA of ≤30 min had lower 28-day mortality rates than those with a TTA of between 31 min and 60 min (3.0% versus 18.1%; log-rankP= 0.0002). Early antibiotic administration was associated with higher survival rates in the context of FN. Efforts should be made to ensure that FN patients receive effective antibiotic therapy as soon as possible. A target of 30 min to the TTA should be adopted for cancer patients with FN.

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