Comparative Quantitative Lymph Node Assessment in Localized Esophageal Cancer Patients After R0 Resection With and Without Neoadjuvant Chemoradiation Therapy

Giugliano, Danica N.; Berger, Adam C.; Pucci, Michael J.; Rosato, Ernest L.; Evans, Nathaniel R.; Meidl, Hanna; Lamb, Casey R.; Levine, Daniel; Palazzo, Francesco

doi:10.1007/s11605-017-3478-y

Cited by 18 publications

(16 citation statements)

References 35 publications

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“…A recent study by Giugliano et al, comparing the quantitative lymph node assessment in patients after R0 resection with or without neoadjuvant chemoradiation therapy, found that total lymph node counts were significantly lower in the chemoradiation therapy group, whereas positive lymph node counts and lymph node ratios did not differ from the upfront surgery group. The overall survival was decreased within the induction therapy cohort among those who had any positive lymph nodes retrieved at surgery 11 . These results were consistent with the findings in our study.…”

Section: Discussionsupporting

confidence: 92%

Surgical Outcomes After Neoadjuvant Chemoradiation Followed by Curative Surgery in Patients With Esophageal Cancer

et al. 2020

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for the Swiss Group for Clinical Cancer Research (SAKK), the German Esophageal Cancer Study Group, the Austrian Arbeitsgemeinschaft Medikamentöse Tumortherapie (AGMT), and the Fédération Francophone de Cancérologie Digestive (FFCD)/Fédération de Recherche en Chirurgie (FRENCH)Objective: To assess the impact of surgical technique in regard to morbidity and mortality after neoadjuvant treatment for esophageal cancer. Background: The SAKK trial 75/08 was a multicenter phase III trial (NCT01107639) comparing induction chemotherapy followed by chemoradiation and surgery in patients with locally advanced esophageal cancer. Methods: Patients in the control arm received induction chemotherapy with cisplatin and docetaxel, followed by concomitant chemoradiation therapy with cisplatin, docetaxel, and 45Gy. In the experimental arm, the same regimen was used with addition of cetuximab. After completion of neoadjuvant treatment, patients underwent esophagectomy. The experimental arm received adjuvant cetuximab. Surgical outcomes and complications were prospectively recorded and analyzed.Results: Total of 259 patients underwent esophagectomy. Overall complication rate was 56% and reoperation rate was 15% with no difference in complication rates for transthoracic versus transhiatal resections (56% vs 54%, P ¼ 0.77), nor for video assisted thoracic surgeries (VATS) versus open transthoracic resections (67% vs 55%, P ¼ 0.32). There was a trend to higher overall complication rates in squamous cell carcinoma versus adenocarcinoma (65% vs 51%, P ¼ 0.035), and a significant difference in ARDS in squamous cell carcinoma with 14% versus 2% in adenocarcinoma (P ¼ 0.0002). For patients with involved lymph nodes, a lymph node ratio of !0.1 was an independent predictor of PFS (HR 2.5, P ¼ 0.01) and OS (HR 2.2, P ¼ 0.03). Conclusions: This trial showed no difference in surgical complication rates between transthoracic and transhiatal resections. For patients with involved lymph nodes, lymph node ratio was an independent predictor of progression free survival and overall survival.

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Section: Discussionsupporting

confidence: 92%

Surgical Outcomes After Neoadjuvant Chemoradiation Followed by Curative Surgery in Patients With Esophageal Cancer

et al. 2020

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“…Several RCTs 1,2,18 have demonstrated that neoadjuvant treatment decreases the number of metastatic nodes, suggesting that the prevalence of supraclavicular metastasis would be lower with neoadjuvant treatment than without. Furthermore, non‐sterilized nodes (despite neoadjuvant treatment) have greater effects on survival than treatment‐naive positive nodes, which could have contributed to the poor prognosis of the present patients with supraclavicular metastasis. Among the 223 patients who underwent prophylactic supraclavicular lymphadenectomy, only two patients with pathologically positive supraclavicular nodes survived without disease.…”

Section: Discussionmentioning

confidence: 94%

Oesophagectomy with or without supraclavicular lymphadenectomy after neoadjuvant treatment for squamous cell carcinoma of the oesophagus

Mine

Watanabe

Kumagai

et al. 2018

British Journal of Surgery

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“…19 Neoadjuvant combination therapy has been shown to decrease LN yield in a variety of cancers including esophageal cancers. 20 One study showed that the total number of resected nodes was significantly associated with survival for patients who underwent surgery alone, but nodal count was not associated with survival in patients who had undergone neoadjuvant combination therapy. 3 Many studies looking at the effect of nodal yield on OS exclude patients who received neoadjuvant chemoradiation therapy.…”

Section: Discussionmentioning

confidence: 99%

Lymph Node Harvest as a Measure of Quality and Effect on Overall Survival in Esophageal Cancer: A National Cancer Database Assessment

Dudash

Slipak

Dove

et al. 2019

The American Surgeon™

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Surgical therapy for esophageal cancer is the cornerstone of treatment, and the highest quality operation should lead to the highest cure rate. Evaluated lymph node (ELN) count is one quality measure that has been championed. The objective of this study was to explore ELN in esophagectomy, examine predictors of harvesting ≥12 nodes, and determine whether higher ELN improves overall survival (OS). ELN was examined in patients with resected esophageal cancer using the National Cancer Database from 2004 to 2013. In this study, 41,746 patients met the inclusion criteria. Fifty-two per cent of patients had 12 or more nodes harvested. Academic programs were most likely to harvest ≥12 nodes (58% of cases) compared with other programs (43–56% of cases). Seventy per cent of cases with ≥12 nodes harvested were performed at high-volume centers. Preoperative radiation or preoperative chemoradiation led to lower ELN (46% and 48%) versus preoperative chemotherapy alone (66%). Multivariate analysis showed that patients who had ≥12 nodes removed had better OS (Hazard Ratio 0.843 [95 confidence interval 0.820–0.867]). In addition, care at a high-volume facility, care at an academic facility, private insurance, and income ≥$63,000 were all associated with improved OS. Higher ELN count is associated with OS in patients with esophageal cancer. Patients who receive care at high-volume centers and academic centers are more likely to undergo more extensive lymphadenectomy. All centers should strive to examine at least 12 nodes to provide a quality esophagectomy.

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Comparative Quantitative Lymph Node Assessment in Localized Esophageal Cancer Patients After R0 Resection With and Without Neoadjuvant Chemoradiation Therapy

Cited by 18 publications

References 35 publications

Surgical Outcomes After Neoadjuvant Chemoradiation Followed by Curative Surgery in Patients With Esophageal Cancer

Surgical Outcomes After Neoadjuvant Chemoradiation Followed by Curative Surgery in Patients With Esophageal Cancer

Oesophagectomy with or without supraclavicular lymphadenectomy after neoadjuvant treatment for squamous cell carcinoma of the oesophagus

Lymph Node Harvest as a Measure of Quality and Effect on Overall Survival in Esophageal Cancer: A National Cancer Database Assessment

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