PS01.144: LYMPH NODE YIELDS AFTER ESOPHAGECTOMY: IMPACT OF APPROACH TO SURGERY AND USE OF NEOADJUVANT THERAPIES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 90-90
Author(s):  
Anindita Marwah ◽  
Pablo Perez Castro ◽  
Paul Carroll ◽  
Marc De Perrot ◽  
Shaf Keshavjee ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Minimally Invasive ◽  
Induction Chemotherapy ◽  
Induction Therapy ◽  
Open Approach ◽  
Lymph Node Yield ◽  
Ivor Lewis ◽  
Induction Chemoradiotherapy ◽  
Node Yield

Abstract Background Although the importance of lymph node (LN) harvest for the adequate staging of esophageal cancer has been well studied, lymph node yields in the literature remain highly variable. Moreover, the effect of modern treatments of esophageal cancer such as induction therapy and minimally invasive approaches on lymph node yield is incompletely understood. Methods A retrospective review of 307 patients who underwent esophagectomy for esophageal cancer between 2005–2013 at Toronto General Hospital was conducted. Early in this experience, thoracoabdominal, transhiatal, Ivor Lewis and Mckeown approaches were utilized with transition over time to fully minimally invasive Ivor Lewis and Mckeown operations. Induction chemoradiotherapy is now our standard for locally advanced esophageal cancer. Demographics, histology, type and approach to esophagectomy, use of induction therapy, lymph node yield, and number of positive lymph nodes were collected. Kruskal-Wallis test was utilized for significance between groups. Results Our population comprised of 239 (78%) males and 68 (22%) females. Adenocarcinoma was the predominant histology at 220 (72%) with 78 (25%) squamous cell carcinoma and 9 (3%) as other histology. 144 (47%) patients had surgery alone, 147 (48%) had induction chemoradiotherapy, and 16 (5%) had induction chemotherapy. The open approach was used in 178 (58%), hybrid minimally-invasive in 33 (11%), fully minimally-invasive in 58 (19%), and transhiatal in 38 (12%). Overall, a median of 24 [IQR17–33; min 3, max 92] nodes were obtained. Induction therapy did not lower our yield (no induction 23[16–32], induction chemotherapy 32.5[17–47], induction chemoradiotherapy 25[19–33], P = 0.07). Transition to a minimally invasive approach similarly did not lower our yield, with only the transhiatal approach showing lower lymph node yield (open 26[17–33], hybrid 33[23–39], fully minimally-invasive 25[19–36], transhiatal 16[11–22], P = 0.005). Conclusion Lymph node yields above 20 can be routinely achieved for adequate staging. Despite the increasing use of induction therapy and minimally-invasive approaches, similar lymph node yields can and should be achieved. Disclosure All authors have declared no conflicts of interest.

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

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.

scholarly journals Safe Introduction of Minimally Invasive Esophagectomy at a Medium Volume Center

2019 ◽  
Vol 109 (2) ◽  
pp. 121-126 ◽  
Author(s):  
G. Linder ◽  
C. Jestin ◽  
M. Sundbom ◽  
J. Hedberg
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Multivariate Regression ◽  
Minimally Invasive Esophagectomy ◽  
Radical Resection ◽  
Tertiary Referral ◽  
Lymph Node Yield ◽  
Tertiary Referral Center ◽  
Invasive Esophagectomy ◽  
Node Yield

Background and Aims: Minimally invasive esophagectomy is a favored alternative in high-volume centers. We evaluated the introduction of, and transition to, minimally invasive esophagectomy at a medium volume tertiary referral center (10–20 esophagectomies annually) with focus on surgical results. Material and Methods: Patients who underwent minimally invasive esophagectomy or open transthoracic surgery for carcinoma of the esophagus or gastroesophageal junction (Siewert I and II) during 2007–2016 were retrospectively studied. Sorted on surgical approach, perioperative data, surgical outcomes, and postoperative complications were analyzed and multivariate regression models were used to adjust for possible confounders. Results: One hundred and sixteen patients were included, 51 minimally invasive esophagectomy (21 hybrid and 30 totally minimally invasive) and 65 open resections. The groups were well matched. However, higher body mass index, neoadjuvant chemoradiotherapy, and cervical anastomosis were more frequent in the minimally invasive esophagectomy group. Minimally invasive esophagectomy was associated with less peroperative bleeding (384 vs 607 mL, p = 0.036) and reduced length of stay (14 vs 15 days, p = 0.042). Duration of surgery, radical resection rate, and postoperative complications did not differ between groups. Lymph node yield was higher in the minimally invasive esophagectomy group, 18 (13–23) vs 12 (8–16), p < 0.001, confirmed in a multivariate regression model (adjusted odds ratio 3.15, 95% class interval 1.11–8.98, p = 0.032). Conclusion: The introduction of minimally invasive esophagectomy at a medium volume tertiary referral center resulted in superior lymph node yield, less peroperative blood loss and shorter length of stay, without compromising the rate of radical resection, or increasing the complication rate.

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

2020 ◽  
Vol 33 (10) ◽  
Author(s):  
V R Esposito ◽  
B A Yerokun ◽  
M S Mulvihill ◽  
M L Cox ◽  
B Y Andrew ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Cox Regression ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Preoperative Radiation ◽  
Lymph Node Yield ◽  
Extensive Lymph Node ◽  
The Impact ◽  
Node Yield

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 (&lt;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 &gt; 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.

Prognostic Value of Lymph Node Yield on Overall Survival in Esophageal Cancer Patients

2019 ◽  
Vol 269 (2) ◽  
pp. 261-268 ◽  
Author(s):  
Els Visser ◽  
Sheraz R. Markar ◽  
Jelle P. Ruurda ◽  
George B. Hanna ◽  
Richard van Hillegersberg
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Prognostic Value ◽  
Lymph Node Yield ◽  
Node Yield

70 IMPACT OF LYMPH NODE YIELD ON SURVIVAL IN PATIENTS UNDERGOING NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY SURGERY FOR LOCALLY ADVANCED ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Xufeng Guo
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Standard Of Care ◽  
Extended Lymphadenectomy ◽  
Advanced Esophageal Cancer ◽  
Lymph Node Yield ◽  
Node Yield ◽  
Locally Advanced Esophageal Cancer

Abstract   A survival benefit of neoadjuvant chemoradiotherapy (nCRT) added to surgery has been demonstrated and therefore is regarded as standard of care for patients with locally advanced esophageal cancer in many countries. It remains unclear whether it is necessary to perform extended lymphadenectomy for patients with esophageal squamous cell carcinoma (ESCC) after nCRT. This study aimed to evaluate the impact of lymph node yield (LNY) on survival in ESCC patients undergoing nCRT plus esophagectomy. Methods Patients receiving R0 resection for locally advanced ESCC were included from the prospective randomized NEOCRTEC5010 trial [surgery (S) alone vs nCRT plus S]. With Cox proportional hazard regression models, the association between survival and LNY as a categorical variable (&lt;20 vs ≥20 nodes) was analyzed in the nCRT group as well as the pCR subgroup. Results Compared with the S group, the nCRT group achieved a better 5-year OS (65.9% vs 55.8%; P = 0.010). Less LNY [20 (IQR 15–27) vs 26 (IQR 19–35); P &lt; 0.001] and positive nodes [0 (IQR 0–1) vs 1 (IQR 0–2.5); P &lt; 0.001] were harvested in nCRT group compared to S group. The number of LNY was significantly associated with OS [HR, 0.363; 95% CI, 0.208–0.635; P &lt; 0.001] and DFS (HR, 0.423; 95% CI, 0.249–0.719; P = 0.001) for patients in nCRT group. Furthermore, an increased LNY was not associated with worse postoperative complications. Conclusion The benefit of a higher lymph node yield on overall and disease-free survival is identified for the patients with ESCC who received nCRT followed by esophagectomy. Therefore, an extended lymphadenectomy should be the standard of care after nCRT.

A comparison of the left thoracoabdominal and Ivor–Lewis esophagectomy

2017 ◽  
Vol 31 (3) ◽  
Author(s):  
A R Davies ◽  
J Zylstra ◽  
C R Baker ◽  
J A Gossage ◽  
D Dellaportas ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neoadjuvant Treatment ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Resection Margins ◽  
Lymph Node Yield ◽  
Ivor Lewis ◽  
Time To Death ◽  
Ivor Lewis Esophagectomy ◽  
Node Yield

SUMMARY The purpose of this study was to assess the oncological outcomes of a large multicenter series of left thoracoabdominal esophagectomies, and compare these to the more widely utilized Ivor–Lewis esophagectomy. With ethics approval and an established study protocol, anonymized data from five centers were merged into a structured database. The study exposure was operative approach (ILE or LTE). The primary outcome measure was time to death. Secondary outcome measures included time to tumor recurrence, positive surgical resection margins, lymph node yield, postoperative death, and hospital length of stay. Cox proportional hazards models provided hazard ratios (HR) with 95% confidence intervals (CI) adjusting for age, pathological tumor stage, tumor grade, lymphovascular invasion, and neoadjuvant treatment. Among 1228 patients (598 ILE; 630 LTE), most (86%) had adenocarcinoma (AC) and were male (81%). Comparing ILE and LTE for AC patients, no difference was seen in terms of time to death (HR 0.904 95%CI 0.749–1.1090) or time to recurrence (HR 0.973 95%CI 0.768–1.232). The risk of a positive resection margin was also similar (OR 1.022 95%CI 0.731–1.429). Median lymph node yield did not differ between approaches (LTE 21; ILE 21; P = 0.426). In-hospital mortality was 2.4%, significantly lower in the LTE group (LTE 1.3%; ILE 3.6%; P = 0.004). Median hospital stay was 11 days in the LTE group and 14 days in the ILE group (P < 0.0001). In conclusion, this is the largest series of left thoracoabdominal esophagectomies to be submitted for publication and the only one to compare two different transthoracic esophagectomy strategies. It demonstrates oncological equivalence between operative approaches but possible short- term advantages to the left thoracoabdominal esophagectomy.

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