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

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

Diseases of the Esophagus ◽

10.1093/dote/doaa007 ◽

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

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.144 ◽

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.

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P81 IMPACT OF LYMPHADENECTOMY ON SURVIVAL AFTER UNIMODALITY TRANSTHORACIC ESOPHAGECTOMY FOR ADENOCARCINOMA OF THE ESOPHAGUS

Diseases of the Esophagus ◽

10.1093/dote/doz092.81 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Hardy K ◽

Kamarajah SK ◽

Madhavan A ◽

Navidi M ◽

Immanuel A ◽

...

Keyword(s):

Lymph Node ◽

Transthoracic Esophagectomy ◽

Lymph Node Yield ◽

Adenocarcinoma Of The Esophagus ◽

Lymph Node Retrieval ◽

Group 3 ◽

Group 2 ◽

The Impact ◽

Node Yield ◽

Group 1

Abstract Aim The aim of this study was to determine the impact of lymph node yield and location on prognosis in patients with esophageal cancer. Background Absolute lymph node yield has been used as a surrogate for the extent of lymphadenectomy for esophagectomy. Ensuring adequate lymphadenectomy requires adequate removal of nodes from surgical fields, thus knowledge of lymph node location is vital to establish the impact of a radical lymphadenectomy. Methods Data from consecutive patients with potentially curable adenocarcinoma of the esophagus or gastro-esophageal junction were reviewed. Patients were treated with transthoracic esophagectomy and two-field lymphadenectomy. Outcomes according to lymph node yield were determined. In addition analysis was carried out based on the hypothesis that retained positive nodes would lead to disease recurrence. The prognosis of carrying out less radical lymphadenectomies was calculated according to three groups: Group 1- exclusion of proximal thoracic nodes, Group 2- a minimal abdominal lymphadenectomy and Group 3- a minimal abdominal and thoracic lymphadenectomy. Results 357 patients were included. Median survival was 78 months(CI 53-103 months). Absolute lymph node retrieval was not related to survival (p=0.920). An estimated additional four (2-6) cancer related deaths was projected if Group 1 nodes were omitted, 15 (11-19) additional deaths if Group 2 nodes omitted, and four (2-6) deaths if Group 3 nodes omitted. A minimal lymphadenectomy (Groups 1,2 and 3) was projected to lead to 19 (15-23) additional cancer related deaths. Conclusions Extensive lymphadenectomy allows accurate staging. In patients who do not receive neoadjuvant chemotherapy it may confer a survival benefit. The absolute number of lymph nodes retrieved may not be a good surrogate for extent of lymphadenectomy and correlation with location is required.

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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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