Optimum lymphadenectomy for esophageal cancer Journal Article
| Authors: | Rizk, N. P.; Ishwaran, H.; Rice, T. W.; Chen, L. Q.; Schipper, P. H.; Kesler, K. A.; Law, S.; Lerut, T. E. M. R.; Reed, C. E.; Salo, J. A.; Scott, W. J.; Hofstetter, W. L.; Watson, T. J.; Allen, M. S.; Rusch, V. W.; Blackstone, E. H. |
| Article Title: | Optimum lymphadenectomy for esophageal cancer |
| Abstract: | OBJECTIVE: Using Worldwide Esophageal Cancer Collaboration data, we sought to (1) characterize the relationship between survival and extent of lymphadenectomy, and (2) from this, define optimum lymphadenectomy. SUMMARY BACKGROUND DATA: What constitutes optimum lymphadenectomy to maximize survival is controversial because of variable goals, analytic methodology, and generalizability of the underpinning data. METHODS: A total of 4627 patients who had esophagectomy alone for esophageal cancer were identified from the Worldwide Esophageal Cancer Collaboration database. Patient-specific risk-adjusted survival was estimated using random survival forests. Risk-adjusted 5-year survival was averaged for each number of lymph nodes resected and its relation to cancer characteristics explored. Optimum number of nodes that should be resected to maximize 5-year survival was determined by random forest multivariable regression. RESULTS: For pN0M0 moderately and poorly differentiated cancers, and all node-positive (pN+) cancers, 5-year survival improved with increasing extent of lymphadenectomy. In pN0M0 cancers, no optimum lymphadenectomy was defined for pTis; optimum lymphadenectomy was 10 to 12 nodes for pT1, 15 to 22 for pT2, and 31 to 42 for pT3/T4, depending on histopathologic cell type. In pN+M0 cancers and 1 to 6 nodes positive, optimum lymphadenectomy was 10 for pT1, 15 for pT2, and 29 to 50 for pT3/T4. CONCLUSIONS: Greater extent of lymphadenectomy was associated with increased survival for all patients with esophageal cancer except at the extremes (TisN0M0 and ≥7 regional lymph nodes positive for cancer) and well-differentiated pN0M0 cancer. Maximum 5-year survival is modulated by T classification: resecting 10 nodes for pT1, 20 for pT2, and ≥30 for pT3/T4 is recommended. Copyright © 2009 by Lippincott Williams & Wilkins. |
| Keywords: | adult; cancer survival; middle aged; cancer surgery; survival rate; major clinical study; histopathology; mortality; squamous cell carcinoma; carcinoma, squamous cell; methodology; lymph node metastasis; lymphatic metastasis; cancer grading; lymph node excision; lymphadenectomy; adenocarcinoma; pathology; risk assessment; cell type; esophagus resection; esophagus cancer; esophagus tumor; esophageal neoplasms; esophagectomy |
| Journal Title: | Annals of Surgery |
| Volume: | 251 |
| Issue: | 1 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2010-01-01 |
| Start Page: | 46 |
| End Page: | 50 |
| Language: | English |
| DOI: | 10.1097/SLA.0b013e3181b2f6ee |
| PUBMED: | 20032718 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 10" - "Export Date: 20 April 2011" - "CODEN: ANSUA" - "Source: Scopus" |
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