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. 2023 Mar 1;277(3):429-436.
doi: 10.1097/SLA.0000000000005028. Epub 2021 Jun 25.

Extent of Lymphadenectomy and Long-term Survival in Esophageal Cancer

Eivind Gottlieb-Vedi  1 , Joonas H Kauppila  1   2 , Fredrik Mattsson  1 , Jakob Hedberg  3 , Jan Johansson  4 , David Edholm  5 , Pernilla Lagergren  6   7 , Magnus Nilsson  8 , Jesper Lagergren  1   9 ; FINEGO group
Collaborators, Affiliations

Extent of Lymphadenectomy and Long-term Survival in Esophageal Cancer

Eivind Gottlieb-Vedi et al. Ann Surg. .

Abstract

Objective: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenec-tomy.

Summary of background data: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.

Methods: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.

Results: Among 2306 patients, the second (4-8 nodes), seventh (21-24 nodes) and eighth decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the first decile [hazard ratio (HR) = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively]. In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.

Conclusion: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.

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Conflict of interest statement

The authors report no conflicts of interest.

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