A Case of Recurrence of Esophageal Cancer to the Posterior Thoracic Paraaortic Lymph Node after Esophagectomy in which Multimodal Therapy Led to a Long-term (54 Months) Survival

Abstract Circumferential resection margins (CRM) of an esophagectomy specimen for oesophageal cancer is a key prognostic factor of overall survival (OS). This retrospective study aims to compare OS of post-esophagectomy patients with CRM of >1 mm (R0) and < 1 mm (R1) with further subgroup analysis of locally advanced T3R0 vs T3R1 resection. Methods A total of 110 esophagectomies conducted between 2010 and 2020 were analysed. We recorded R stage based on pathological CRM >1 mm (R0) or < 1 mm (R1). OS was calculated from the day of surgery to day of death or otherwise censored. All patients underwent multimodal therapy including chemotherapy and similar pre-surgical and post-surgical management. 58 of these patients with pT3 stage esophageal cancer (EC) were selected and compared. Statistical analysis was carried out using SPSS. Results Of 110 patients, 78 (71.5%) patients had a R0 resection. Mean OS in R0 resections was 73 months (6 years) compared to 25.2 months (2 years) in R1 resection (p = 0.001). 58 of the 110 patients were pathological stage T3(pT3) despite downstaging with chemotherapy showing the burden of advanced disease. In patients with stage pT3 (n = 58), 32 patients were R0 resections, and 26 patients had R1 resections. Mean OS in T3R0 resections was 51.5 months compared to 28.5 months in T3R1 resection. OS comparison is significant (p = 0.011). Conclusion This study emphasizes the importance of clear CRM in all patients and especially in locally advanced pT3/T4a esophageal cancer in achieving long term survival. Techniques used to ensure a clear CRM such multimodality therapy combined with surgical radical resection concepts such as mesoesophagectomy should be employed.

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A Propensity Score-Matched Cohort Study to Evaluate the Association of Lymph Node Retrieval with Long-Term Overall Survival in Patients with Esophageal Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-020-09142-w ◽

2020 ◽

Vol 28 (1) ◽

pp. 133-141 ◽

Cited By ~ 1

Author(s):

Leonie R. van der Werf ◽

Elske Marra ◽

Suzanne S. Gisbertz ◽

Bas P. L. Wijnhoven ◽

Mark I. van Berge Henegouwen

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Propensity Score ◽

Neoadjuvant Chemoradiotherapy ◽

Stage Migration ◽

Matched Cohort ◽

Term Survival ◽

Node Negative ◽

Pathological Staging

Abstract Background Previous studies evaluating the association of lymph node (LN) yield and survival presented conflicting results and many may be influenced by confounding and stage migration. Objective This study aimed to evaluate whether the quality indicator ‘retrieval of at least 15 LNs’ is associated with better long-term survival and more accurate pathological staging in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy and resection. Methods Data of esophageal cancer patients who underwent neoadjuvant chemoradiotherapy and surgery between 2011 and 2016 were retrieved from the Dutch Upper Gastrointestinal Cancer Audit. Patients with < 15 and ≥ 15 LNs were compared after propensity score matching based on patient and tumor characteristics. The primary endpoint was 3-year survival. To evaluate the effect of LN yield on the accuracy of pathological staging, pathological N stage was evaluated and 3-year survival was analyzed in a subgroup of patients with node-negative disease. Results In 2260 of 3281 patients (67%) ≥ 15 LNs were retrieved. In total, 992 patients with ≥ 15 LNs were matched to 992 patients with < 15 LNs. The 3-year survival did not differ between the two groups (57% vs. 54%; p = 0.28). pN+ was scored in 41% of patients with ≥ 15 LNs versus 35% of patients with < 15 LNs. For node-negative patients, the 3-year survival was significantly better for patients with ≥ 15 LNs (69% vs. 61%, p = 0.01). Conclusions n this propensity score-matched cohort, 3-year survival was comparable for patients with ≥ 15 LNs, although increasing nodal yield was associated with more accurate staging. In node-negative patients, 3-year survival was higher for patients with ≥ 15 LNs.

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Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-019-03122-8 ◽

2020 ◽

Vol 146 (4) ◽

pp. 961-969 ◽

Cited By ~ 1

Author(s):

Thomas Papathemelis ◽

Helen Oppermann ◽

Stella Grafl ◽

Michael Gerken ◽

Armin Pauer ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

High Risk ◽

Paraaortic Lymph Node ◽

Node Dissection ◽

Term Outcome ◽

Long Term Outcome ◽

Open Procedure ◽

Paraaortic Lymph Node Dissection

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Selecting esophageal cancer patients for lymphadenectomy after neoadjuvant chemoradiotherapy: a modeling study

BMJ Surgery, Interventions, & Health Technologies ◽

10.1136/bmjsit-2019-000027 ◽

2020 ◽

Vol 2 (1) ◽

pp. e000027

Author(s):

Mirre Scholte ◽

Didi JJM de Gouw ◽

Bastiaan R Klarenbeek ◽

Janneke PC Grutters ◽

Camiel Rosman ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Success Rate ◽

Cancer Patients ◽

Treatment Success ◽

Neoadjuvant Chemoradiotherapy ◽

Sensitivity Analyses ◽

Short Term ◽

Life Years

ObjectivesTwo-thirds of patients do not harbor lymph node (LN) metastases after neoadjuvant chemoradiotherapy (nCRT). Our aim was to explore under which circumstances a selective lymph node dissection (LND) strategy, which selects patients for LND based on the restaging results after nCRT, has added value compared with standard LND in esophageal cancer.DesignA decision tree with state-transition model was developed. Input data on short-term and long-term consequences were derived from literature. Sensitivity analyses were conducted to assess promising scenarios and uncertainty.SettingDutch healthcare system.ParticipantsHypothetical cohort of esophageal cancer patients who have already received nCRT and are scheduled for esophagectomy.InterventionsA standard LND cohort was compared with a cohort of patients that received selective LND based on the restaging results after nCRT.Main outcome measuresQuality-adjusted life years (QALYs), residual LN metastases and LND-related complications.ResultsSelective LND could have short-term benefits, that is, a decrease in the number of performed LNDs and LND-related complications. However, this may not outweigh a slight increase in residual LN metastases which negatively impacts QALYs in the long-term. To accomplish equal QALYs as with standard LND, a new surgical strategy should have the same or higher treatment success rate as standard LND, that is, should show equal or less recurrences due to residual LN metastases.ConclusionsThe reduction in LND-related complications that is accomplished by selecting patients for LND based on restaging results after nCRT seems not to outweigh a QALY loss in the long-term due to residual LN metastases. Despite the short-term advantages of selective LND, this strategy can only match long-term QALYs of standard LND when its success rate equals the success rate of standard LND.

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