Lymphadenectomy Extent During Esophageal Cancer Surgery May Not Impact Survival

The extent of lymphadenectomy during surgery for esophageal cancer might not influence 5-year all-cause or disease-specific survival, a finding that challenges current clinical guidelines, a new study published online ahead of print in JAMA Surgery has shown.¹

Because the prognostic significance of the extent of lymphadenectomy during surgery for esophageal cancer is unclear, researchers sought to determine whether the number of removed lymph nodes impacts survival in patients undergoing surgery for esophageal cancer.

For the study, researchers analyzed data from 606 patients who underwent esophagectomy for esophageal cancer between 2000 and 2012, with follow-up until 2014. Of those, 83.5% had adenocarcinoma of the esophagus, 53% died within 5 years of surgery, and 39% died of tumor recurrence.

Results showed that the extent of lymphadenectomy was not statistically significantly associated with all-cause or disease-specific mortality.

Researchers found that patients who had 21 to 52 lymph nodes removed did not have a statistically significant reduction in all-cause mortality compared with those who had 10 or fewer nodes removed (HR = 0.86; 95% CI: 0.63-1.17), particularly between 2007 and 2012 (HR = 0.98; 95% CI: 0.57-1.66).

The study also demonstrated that a greater number of metastatic nodes and higher positive to negative node ratio was associated with increased mortality rates.

Current clinical guidelines recommend 2-field (extensive) lymphadenectomy, but in routine clinical practice, it is up to the discretion of the individual surgeon to determine the preferred extent of lymphadenectomy.

Reference

1. Lagergren J, Mattsson F, Zylstra J, et al. Extent of lymphadenectomy and prognosis after esophageal cancer surgery [published online ahead of print on September 2, 2015]. JAMA Surg. doi: 10.1001/jamasurg.2015.2611.