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

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.

scholarly journals Predictors of Survival in Esophageal Squamous Cell Carcinoma with Pathologic Major Response after Neoadjuvant Chemoradiation Therapy and Surgery: The Impact of Chemotherapy Protocols

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Chia-Ying Li ◽  
Pei-Ming Huang ◽  
Pei-Yi Chu ◽  
Po-Ming Chen ◽  
Mong-Wei Lin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Disease Progression ◽  
Cancer Patients ◽  
Chemoradiation Therapy ◽  
Major Response

Tumor recurrence is an important problem threatening esophageal cancer patients after surgery, even when they achieve a pathologic major response (pMR) after neoadjuvant concurrent chemoradiation therapy (CCRT). The predictors related to overall survival and disease progression for these patients remain elusive. We aimed to identify factors that predict disease progression and overall survival in esophageal squamous cell carcinoma (SCC) patients who achieve a pMR after neoadjuvant CCRT followed by surgery. We conducted a retrospective study to analyze the factors influencing survival and disease progression after esophagectomy for esophageal cancer patients who had a major response to CCRT, which is defined by complete pathological response or microscopic residual disease without lymph node metastasis. From our study cohort, 285 patients underwent CCRT and subsequent esophagectomy; 171 (60%) of these patients achieved pMR. After excluding patients with lymph node metastases, incomplete clinical data, and adenocarcinomas, we enrolled 117 patients in this study. We found that the CCRT regimen was the only factor that influenced overall survival. The overall survival of the patients receiving taxane-incorporated CCRT was superior to that of patients receiving traditional cisplatin and 5-fluorouracil (PF) (P=0.011). The CCRT regimen can significantly influence the clinical outcome of esophageal SCC patients who achieve pMR after neoadjuvant CCRT and esophagectomy. Incorporation of taxanes into cisplatin-based CCRT may be associated with prolonged survival.

FA06.02: OPTIMAL EXTENT OF LYMPH NODE DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 11-12
Author(s):  
Long-Qi Chen ◽  
Yu-Shang Yang
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Positive Lymph Node ◽  
Node Negative ◽  
Kaplan Meier

Abstract Background The possible presence of occult tumor dissemination is the rationale of radical systematic lymphadenectomy. Theoretically, the more extent of lymphadenectomy, the more similar survival outcomes between node-negative and node-positive patients. Accordingly, there will be a certain number of examined lymph nodes (NELN) for patients with only one tumor-positive lymph node that can equal their survival with the node-negative patients, and this cut-off point should be define the minimal requirement for an adequate extent of lymphadenectomy. The aim of this report was to determine the optimal number of examined lymph nodes (NELN) dissection for esophageal squamous cell carcinoma (ESCC) by this novel method. Methods We retrospectively reviewed 589 ESCC patients from June 2011 and July 2012. Among them, 372 patients were pathologically confirmed with node-negative (N 0 + ), and 217 patients with only one tumor-positive lymph node (N 1 + ). Comparison of overall survival were performed using the Kaplan-Meier method. Cox regression hazard model was used for multivariate analysis to assess the independent influence of NELN on overall survival. Results The median survival for N 0 + and N 1 + patients was 32 versus 23 months (HR 1.61; 95% CI 22.86- 29.148; P = 0.000). Survival analyses revealed that the NELN positively correlated with overall survival (OS) both for patients with N 0- (P = 0.024) and N 1 + (P = 0.046), and an independent prognostic predictor only for N 0 + patients (hazard ratio 0.984; P = 0.032). When the cut-off point of NELN was set as a value less than 18, stratum analysis within the Kaplan–Meier method showed that NELN did not affect the results that N 1 + patients have a worse overall survival as compared with N 0 + patients (P < 0.05). However, stratum analysis showed that no significant difference in OS was observed between N 1 + and N 0 + patients when the NELN was greater than 18. Conclusion The NELN should be considered a mandatory requirement for improving the OS of ESCC patients. The minimum of 18 lymph nodes removed for ESCC is rational and should be complied with. Disclosure All authors have declared no conflicts of interest.

RA03.04: COMPARISON OF THE CLINICAL OUTCOMES OF ESOPHAGECTOMY AND CHEMORADIOTHERAPY AFTER NONCURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 23-23
Author(s):  
Yasufumi Koterazawa ◽  
Tetsu Nakamura ◽  
Taro Oshikiri ◽  
Shingo Kanaji ◽  
Kimihiro Yamashita ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Endoscopic Submucosal Dissection ◽  
Cell Carcinoma ◽  
Tumor Invasion ◽  
Lymphovascular Invasion ◽  
Definitive Treatment

Abstract Background Endoscopic submucosal dissection (ESD) is widely used to treat esophageal cancer, but some patients require additional definitive treatment owing to the possibility of residual tumor cells or lymph node metastasis. The aim of this study was to elucidate the efficacy and clinical outcomes of these additional treatments. Methods ESD was performed for cT1a esophageal cancer, and additional definitive treatment was recommended for patients who had undergone noncurative ESD for submucosa (SM) or muscularis mucosae cancers with lymphovascular invasion and a positive resection margin. The study included 59 patients who developed superficial esophageal squamous cell carcinoma after noncurative ESD treated between 2005 and 2016, of whom 28 underwent esophagectomy with lymph node dissection and 31 received chemoradiotherapy (CRT) by choice or because their conditions did not permit surgery. Results The median follow-up periods were 45 months (range, 3–89 months) in the esophagectomy group and 41 months (range, 12–84 months) in the CRT group. Overall survival didn’t differ between the groups (P = 0.46). But there were no recurrences in the esophagectomy group, and the disease-specific survival rate was significantly higher in this group (P = 0.042). Among the patients at high risk for recurrence owing to massive tumor invasion (≥ SM2) with lymphovascular invasion (esophagectomy group, 6 patients; CRT group, 10 patients), none in the esophagectomy group had a recurrence, whereas 4 in the CRT group died of esophageal cancer (P = 0.031). Conclusion Overall survival did not differ between the esophagectomy and CRT groups after noncurative ESD. However, compared with CRT, esophagectomy provided more favorable disease control for patients with massive tumor invasion (≥ SM2) with lymphovascular invasion. Disclosure All authors have declared no conflicts of interest.

PS01.194: CLINICOPATHOLOGICAL EXAMINATION OF ESOPHAGOGASTRIC JUNCTIONAL CARCINOMA TREATED WITH CURATIVE SURGERY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 104-105
Author(s):  
Sachiko Kaida ◽  
Tsuyoshi Yamaguchi ◽  
Katsushi Takebayashi ◽  
Toru Miyake ◽  
Hiroya Iida ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Curative Surgery ◽  
Japanese Classification ◽  
Right Thoracotomy

Abstract Background Compared to Western countries, Japanese esophagogastric junctional carcinoma (JC) demonstrates different epidemiologic backgrounds; squamous cell carcinoma is dominant over Barrett adenocarcinoma, and there is no consensus on surgical approach or dissection range of lymph node. JC is defined as the cancer, that is the center of the tumor is within 2 cm from the esophagogastric junction to the esophagus and stomach respectively by the Japanese Classification of Esophageal Cancer, 11th edition. According to this definition, we examined the clinicopathological features and treatment outcomes of patients who underwent curative resection and pathologically defined as JC. Methods From 2012 to 2018, 19 consecutive patients with JC who received with curative surgery in Shiga University of Medical Science Hospital were included. Clinicopathological classification was based on Japanese Classification of Esophageal Cancer, 11th edition. Results The patients consisted of 14 males and 5 females, median age was 68 (43–91) years old. Pathological diagnoses were 15 adenocarcinoma, 1 squamous cell carcinoma, 2 mixed adenoneuroendocrine carcinoma (MANEC) and 1 malignant melanoma. Patients with Barrett's esophagus were 6 cases (31.6%). Median tumor diameter was 54 mm (5–90 mm) and tumor location was E:3 cases (15.8%), EG:6 cases (31.6%), E = G:1 case (5.2%), GE:8 cases (42.1%) and G:1 case (5.2%). Surgical procedure was esophagectomy via right thoracotomy 6 cases, esophagectomy via left thoracotomy 2 case and laparotomy 11 cases. Tumor invasion was pT1:6 (31.6%), pT2:3 (15.8%), pT3:3 (15.8%) and pT4:7 (36.8%). Lymph node metastases were observed in 13 cases (68.4%) and #1,2,3:13 cases (100%), #4,5: 2 cases (15.4%), #7,8a,9: 4 cases (30.8%), #19,20: 3 cases (23.1%) and #105–110: 3 cases (23.1%). Among 7 recurrence patients, peritonitis carcinomatosa was 4 cases. Conclusion In all positive lymph node metastasis cases, metastasis was observed in #1, 2 and 3 lymph nodes, but metastasis to the cervical lymph node was not observed. In the G, GE cases, right thoracotomy was not performed because there were no metastases to the upper mediastinal lymph nodes. In conclusion, these results suggested that surgical operation could be reduced to proximal gastrectomy for early G, GE cases. However, the number of cases is small in this study, further investigation is necessary. Disclosure All authors have declared no conflicts of interest.

Role of Clinical Palpation in Evaluation of Cervical Lymph Node in Oral Squamous Cell Carcinoma

2013 ◽  
Vol 1 (2) ◽  
pp. 02-06
Author(s):  
SM Anwar Sadat ◽  
Sufia Nasrin Rita ◽  
Shoma Banik ◽  
Md Nazmul Hasan Khandker ◽  
Md Mahfuz Hossain ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Oral Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Predictive Value ◽  
Cervical Lymph Node ◽  
Betel Quid ◽  
Cervical Lymph Nodes

A cross sectional study of 29 cases of oral squamous cell carcinoma with or without  cervical lymph node metastasis was done among Bangladeshi patients from January 2006 to December 2007. Majority of the study subjects (34.5%) belonged to the age group of 40-49 years. 58.6% of the study subjects were male, while remaining 41.4% of them were female. 51.7% of the lesions were located in the alveolar ridge where the other common sites were buccal mucosa (27.6%) and retro molar area (13.8%). Half of the study subjects (51.7%) were habituated to betel quid chewing followed by 37.9% and 10.3% were habituated to smoking and betel quid-smoking respectively. Grade I lesions was most prevalent (75.9%) in the study subjects.  Majority of cases presented with Stage IV lesions (55.2%). The sensitivity, specificity, positive predictive value, negative predictive value & accuracy of clinical palpation method for determining metastatic cervical lymph nodes were 93.33%, 64.29%, 73.68%, 90% and 79.3% respectively. Careful and repeated clinical palpation plays important role in evaluation of cervical lymph nodes though several modern techniques may help additionally in the management of oral cancer.DOI: http://dx.doi.org/10.3329/updcj.v1i2.13978 Update Dent. Coll. j. 2011: 1(2): 02-06

scholarly journals Mapping of Cervical and Upper Mediastinal Lymph Node Recurrence for Guiding Clinical Target Delineation of Postoperative Radiotherapy in Thoracic Esophageal Squamous Cell Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Yichun Wang ◽  
Dongmei Ye ◽  
Mei Kang ◽  
Liyang Zhu ◽  
Mingwei Yang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Mediastinal Lymph Node ◽  
Postoperative Radiotherapy ◽  
Vena Cava ◽  
Lymph Node Recurrence

BackgroundThe lower neck and upper mediastinum are the major regions for postoperative radiotherapy (PORT) in thoracic esophageal squamous cell carcinoma (TESCC). However, there is no uniform standard regarding the delineation of nodal clinical target volume (CTVnd). This study aimed to map the recurrent lymph nodes in the cervical and upper mediastinal regions and explore a reasonable CTVnd for PORT in TESCC.MethodsWe retrospectively reviewed patients in our hospital with first cervical and/or upper mediastinal lymph node recurrence (LNR) after upfront esophagectomy. All of these recurrent lymph nodes were plotted on template computed tomography (CT) images with reference to surrounding structures. The recurrence frequency at different stations was investigated and the anatomic distribution of recurrent lymph nodes was analyzed.ResultsA total of 119 patients with 215 recurrent lymph nodes were identified. There were 47 (39.5%) patients with cervical LNR and 102 (85.7%) patients with upper mediastinal LNR. The high-risk regions were station 101L/R, station 104L/R, station 106recL/R, station 105 and station 106pre for upper TESCC and station 104L/R, station 106recL/R, station 105, station 106pre and station 106tbL for middle and lower TESCCs. LNR in the external group of station 104L/R was not common, and LNR was not found in the narrow spaces where the trachea was in close contact with the innominate artery, aortic arch and mediastinal pleura. LNR below the level of the cephalic margin of the superior vena cava was also not common for upper TESCC.ConclusionsThe CTVnd of PORT in the cervical and upper mediastinal regions should cover station 101L/R, station 104L/R, station 106recL/R, station 105 and station 106pre for upper TESCC and station 104L/R, station 106recL/R, station 105, station 106pre and station 106tbL for middle and lower TESCCs. Based on our results, we proposed a useful atlas for guiding the delineation of CTVnd in TESCC.

Lymph node status assessment in head and neck squamous cell carcinoma in patients with clinically non palpable lymph nodes: Meta-analysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hany Riad ◽  
Samer Ibrahim ◽  
Amr Gouda ◽  
Ossama Mustafa ◽  
Heba Mohamed
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Meta Analysis ◽  
Lymph Node Status ◽  
Lymph Node Staging ◽  
Pet Ct

Abstract Background The most important prognostic factor in squamous cell carcinoma of the head and neck (HNSCC) is the presence or absence of clinically involved neck nodes. The presence of metastases in a lymph node is said to reduce the 5-years survival rate by about 50%. The appropriate diagnosis of the presence of metastatic node is very important for the management of HNSCC Aim To compare difTerent diagnostic modalities for assessment of the clinically non palpable lymph nodes in HNSCC including by meta-analysis: CT, MRI, US, USFNAC and PET/CT for the proper cervical lymph node staging. Methods Met-analysis study on patients with HNSCC of clinically non palpable lymph nodes (cN0). Results Analysis was divided in 6 groups .Each group contain analysis of one modality according to available studies per patient, per level and per lesion .US is fair test per patient and per lesion.CT is good test per patient and excellent test per lesion.MRI is poor test per patient and fair test per lesion.CT-MRl combined is fair per patient and excellent per level.PET/CT is good per patient, fair per lesion and excellent per level. USFNAC is excellent per lesion. Conclusion CT, CT-MRI combined, PET/CT and USFNAC proved to be excellent in detecting cN0.MRI was poor test in detecting cN0.US was a fair test in detecting cN0 if used alone.

PS02.004: THE FEASIBILITY AND EFFECTIVENESS OF ‘TOTAL ENDOSCOPIC 2.5 FIELD LYMPH NODE DISSECTION’ IN TREATMENT OF THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 120-121
Author(s):  
Bin Zheng ◽  
Ruopeng Hong ◽  
Shuliang Zhang ◽  
Taidui Zeng ◽  
Hao Chen ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Lymph Node Dissection ◽  
Squamous Cell ◽  
Node Dissection ◽  
Recurrent Laryngeal Nerves ◽  
The Right

Abstract Background Due to the difficulty of dissection, surgical trauma, postoperative complications and other factors, the promotion of 3-field lymph node dissection is subject to certain restrictions. We try to explore and summarize a method of lymph node dissection, ‘endoscopic 2.5 lymph node dissection ’, that is, thoracoscopy combined with laparoscopic radical abdominal field, chest field and lower cervical paraesophageal lymph nodes (including 101 group below thyroid artery). Methods Retrospective analysis of 240 patients with thoracic esophageal squamous cell carcinoma from November 1, 2015 to December 31, 2017. All patients underwent endoscopic 2.5-field lymphadenectomy. The average age is (58.2 ± 9.5) years old. During the thoracoscopic part, when we do the lymphadenectomy along recurrent laryngeal nerves in the upper mediastimun and lower neck, we used a combination of ‘esophageal suspension method’, ‘lymph node rolling dissection method’ and ‘multi-angle pulling method’ to reveal the lymph nodes (Figure 1). Surgical related factors were collected and analyzed. Continuous follow-up was performed to record the recurrence and metastasis of patients and postoperative survival. Results Lymphadenectomy level of the right recurrent laryngeal nerve could reach the level above the right inferior thyroid artery, and the left could reach the level of 101 station. All operations were successfully completed. The incidence of pulmonary infection was 11.7%, the incidence of anastomotic leakage was 1.3%, the hoarseness rate was 7.9% and the incidence of chylothorax was 4.2%. The average number of total, abdominal and thoracic lymph nodes dissected were higher than the number of guidelines requirement and most of the previous literature. The average postoperative hospital stay was 8.4 days. The local recurrence rate, metastasis rate and survival rate of all the patients were not inferior to those reported in the past. Conclusion In patients with thoracic esophageal squamous cell carcinoma, the use of ‘total endoscopic 2.5-field lymph noede dissection’, could expand the range of lymph node dissection, and reached the super-thoracic and lower cervical level, which is beneficial to improve the degree of dissection along the recurrent laryngeal nerves. The procedure is safe and feasible, the results of short-term follow-up results are good, and it is worth further promotion. Disclosure All authors have declared no conflicts of interest.

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