The optimal lymph node dissection in patients with adenocarcinoma of the esophagogastric junction

TY - JOUR

T1 - The optimal lymph node dissection in patients with adenocarcinoma of the esophagogastric junction

AU - Okholm, Cecilie

AU - Fjederholt, Kaare Terp

AU - Mortensen, Frank Viborg

AU - Svendsen, Lars Bo

AU - Achiam, Michael Patrick

N1 - Copyright © 2017 Elsevier Ltd. All rights reserved.

PY - 2018/3

Y1 - 2018/3

N2 - OBJECTIVE: The aim of this study was to refine the optimal lymph node dissection in Western patients with adenocarcinoma of the esophagogastric junction (AEG).BACKGROUND: Lymphadenectomy is essential in addition to surgery for AEG. Asian studies continually present superior survival rates using a more extended lymphadenectomy compared with results reproduced in the West. Thus, the optimal extend of the lymphadenectomy remains unclear in Western patients.METHODS: A retrospective cohort was conducted of patients with AEG from January 1st, 2003 to December 31st, 2011. All patients undergoing curatively intended surgery was included. Two types of resections were constructed; Res1 included patients where only the loco regional lymph nodes were removed (station 1-4, 7 and 9) and Res2 included the additional removal of the more distant stations 8 and/or 11.RESULTS: We identified 510 patients with AEG. The highest frequency of lymph node metastases was seen in the loco regional stations 1-3, 7 and 9, ranging from 34% to 41.4%. There was no difference in overall survival between the two groups; the median survival rate for Res1 was 30.4 months compared to 24.1 months for Res2 (p = 0.157). Furthermore, the extend of lymph node dissection seemed to have no effect on survival (HR = 1.061, 95%CI 0.84-1.33).CONCLUSION: No significant difference in survival between the extended and the less extended lymphadenectomy was found. The presence of metastases in distant lymph nodes indicates poor survival and may represent disseminated disease. We do not find evidence that supports an extended lymph node dissection in Western patients.

AB - OBJECTIVE: The aim of this study was to refine the optimal lymph node dissection in Western patients with adenocarcinoma of the esophagogastric junction (AEG).BACKGROUND: Lymphadenectomy is essential in addition to surgery for AEG. Asian studies continually present superior survival rates using a more extended lymphadenectomy compared with results reproduced in the West. Thus, the optimal extend of the lymphadenectomy remains unclear in Western patients.METHODS: A retrospective cohort was conducted of patients with AEG from January 1st, 2003 to December 31st, 2011. All patients undergoing curatively intended surgery was included. Two types of resections were constructed; Res1 included patients where only the loco regional lymph nodes were removed (station 1-4, 7 and 9) and Res2 included the additional removal of the more distant stations 8 and/or 11.RESULTS: We identified 510 patients with AEG. The highest frequency of lymph node metastases was seen in the loco regional stations 1-3, 7 and 9, ranging from 34% to 41.4%. There was no difference in overall survival between the two groups; the median survival rate for Res1 was 30.4 months compared to 24.1 months for Res2 (p = 0.157). Furthermore, the extend of lymph node dissection seemed to have no effect on survival (HR = 1.061, 95%CI 0.84-1.33).CONCLUSION: No significant difference in survival between the extended and the less extended lymphadenectomy was found. The presence of metastases in distant lymph nodes indicates poor survival and may represent disseminated disease. We do not find evidence that supports an extended lymph node dissection in Western patients.

KW - Adenocarcinoma/pathology

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Esophageal Neoplasms/pathology

KW - Esophagectomy/mortality

KW - Esophagogastric Junction/pathology

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Lymph Node Excision/mortality

KW - Lymphatic Metastasis

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Prospective Studies

KW - Retrospective Studies

KW - Survival Rate

U2 - 10.1016/j.suronc.2017.11.004

DO - 10.1016/j.suronc.2017.11.004

M3 - Journal article

C2 - 29549902

SN - 0960-7404

VL - 27

SP - 36

EP - 43

JO - Surgical Oncology

JF - Surgical Oncology

IS - 1

ER -