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Review
. 2024 Apr 2;37(4):doad065.
doi: 10.1093/dote/doad065.

History and evidence for state of the art of lymphadenectomy in esophageal cancer surgery

Nannet Schuring  1   2   3 , Mark I van Berge Henegouwen  1   2 , Suzanne S Gisbertz  1   2
Affiliations
Review

History and evidence for state of the art of lymphadenectomy in esophageal cancer surgery

Nannet Schuring et al. Dis Esophagus. .

Abstract

The current curative multimodal treatment of advanced esophageal cancers consists of neoadjuvant or perioperative chemo(radio)therapy followed by a radical surgical resection of the primary tumor and a 2- or 3-field lymphadenectomy. One of the most important predictors of long-term survival of esophageal cancer patients is lymph node involvement. The distribution pattern of lymph node metastases in esophageal cancer is unpredictable and depends on the primary tumor location, histology, T-stage and application of neoadjuvant or perioperative treatment. The optimal extent of the lymphadenectomy remains controversial; there is no global consensus on this topic yet. Some surgeons advocate an aggressive and extended lymph node dissection to remove occult metastatic disease, to optimize oncological outcomes. Others promote a more restricted lymphadenectomy, since the benefit of an extended lymphadenectomy, especially after neoadjuvant chemoradiotherapy, has not been clearly demonstrated, and morbidity may be reduced. In this review, we describe the development of lymphadenectomy, followed by a summary of current evidence for lymphadenectomy in esophageal cancer treatment.

Keywords: esophageal cancer; esophagectomy; lymph node; lymphadenectomy; upper GI surgery.

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Conflict of interest statement

MIvBH reports grants from Olympus and Stryker; personal fees from Johnson and Johnson, Medtronic, Mylan and Alesi Surgical. All fees paid to institution outside the submitted work.

The other authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Timeline of the evolution in esophageal cancer care.
Fig. 2
Fig. 2
Extent of the lymphadenectomy. Overview of TIGER classification of locoregional lymph node stations of esophageal cancer. EM2F, extended mediastinal 2-field dissection; l/r, left/right; r, right; TM2FD, total mediastinal 2-field dissection; 3FD, 3-field dissection. [Partly re-used own figure from ‘Distribution of lymph node metastases in esophageal carcinoma [TIGER study]: study protocol of a multinational observational study’ by E.R.C. Hagens et al. published in ‘BMC Cancer’ (2019) 19:662 with permission from authors.
Fig. 3
Fig. 3
Recommended lymphadenectomy for esophageal squamous cell carcinoma. Based on the Japanese Classification of Esophageal cancer (11th edition), nodes from group 1, 2 and 3 are regarded as locoregional lymph nodes and should therefore at least be resected during lymphadenectomy. Ae, abdominal esophagus; Abd, abdominal lymph node stations; Ce, cervical esophagus; Cer, cervical lymph node stations; Lt, lower thoracic esophagus; Mt, middle thoracic esophagus; SCC, squamous cell carcinoma; Th, thoracic lymph node stations; Ut, upper thoracic esophagus;
Fig. 4
Fig. 4
Recommended lymphadenectomy for esophageal adenocarcinoma. Based on the ESMO guidelines for esophageal cancer, 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction.,,, Abd, abdominal lymph node stations; AC, adenocarcinoma; GEJ, gastroesophageal junction; Lt, lower thoracic esophagus; Th, thoracic lymph node stations. *According to the JES (11th edition), ^According to the AJCC (8th edition) Amin et al., Obermannová et al. and Hagens et al.
See this image and copyright information in PMC

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