Impact of increasing lymph node yield on staging, morbidity and survival after esophagectomy for esophageal adenocarcinoma

Henckens, Sofie; Hagens, Eliza; Henegouwen, Mark I. van Berge; Meijer, Sybren L.; Eshuis, Wietse J.; Gisbertz, Suzanne S.

doi:10.1016/j.ejso.2022.07.012

Cited by 9 publications

(5 citation statements)

References 35 publications

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“…As a result of extensive lymphadenectomy, the clearance of malignant lymphatic tissue is maximized, improving DFS, and hence OS. 21,22 This is strengthened by the results of a randomized controlled trial suggesting a possible improvement in oncologic outcomes after minimally invasive, as compared with open, esophagectomy. 23 In the traditionally invasive vs. minimally invasive esophagectomy trial, although not statistically significant, 3-year DFS was 40.2% after TMIE as compared with 35.9% after OE, whereas 3-year OS of 50.5% after TMIE compared with 40.4% after OE was observed.…”

Section: Discussionmentioning

confidence: 99%

“…This superiority on several surgical quality indicators, probably as a result of better visualization and more precise lymph node dissection during minimally invasive surgery, might have led to more optimal local tumor control, reducing recurrence rate and prolonging survival. As a result of extensive lymphadenectomy, the clearance of malignant lymphatic tissue is maximized, improving DFS, and hence OS 21,22 . This is strengthened by the results of a randomized controlled trial suggesting a possible improvement in oncologic outcomes after minimally invasive, as compared with open, esophagectomy 23 .…”

Section: Discussionmentioning

confidence: 99%

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Recurrence and Survival After Minimally Invasive and Open Esophagectomy for Esophageal Cancer

Henckens,

Schuring,

Elliott

et al. 2024

Annals of Surgery

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Objective: The aim of this study was to determine the impact of operative approach (open [OE], hybrid [HMIE] and total minimally invasive esophagectomy [TMIE]) on operative and oncologic outcomes for patients treated with curative intent for esophageal and junctional cancer. Summary Background Data: The optimum oncologic surgical approach to esophageal and junctional cancer is unclear. Methods: This secondary analysis of the European multicenter ENSURE study includes patients undergoing curative-intent esophagectomy for cancer between 2009–2015 across 20 high-volume centers. Primary endpoints were disease-free survival (DFS) and the incidence and location of disease recurrence. Secondary endpoints included among others R0 resection rate, lymph node yield and overall survival (OS). Results: In total, 3,199 patients were included. Of these, 55% underwent OE, 17% HMIE and 29% TMIE. DFS was independently increased post TMIE (HR 0.86 [95% CI 0.76-0.98], P=0.022) compared with OE. Multivariable regression demonstrated no difference in absolute locoregional recurrence risk according to operative approach (HMIE vs. OE OR 0.79, P=0.257, TMIE vs. OE OR 0.84, P=0.243). The probability of systemic recurrence was independently increased post HMIE (OR 2.07, P=0.031), but not TMIE (OR 0.86, P=0.508). R0 resection rates (P=0.005) and nodal yield (P<0.001) were independently increased after TMIE, but not HMIE (P=0.424; P=0.512) compared with OE. OS was independently improved following both HMIE (HR 0.79, P=0.009) and TMIE (HR 0.82, P=0.003) as compared with OE. Conclusion: In this European multicenter study, TMIE was associated with improved surgical quality and DFS, while both TMIE and HMIE were associated with improved OS as compared with OE for esophageal cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recurrence and Survival After Minimally Invasive and Open Esophagectomy for Esophageal Cancer

Henckens,

Schuring,

Elliott

et al. 2024

Annals of Surgery

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“…Upon examining the impacts of these surgical techniques on the criteria defining TBO, it was observed that patients undergoing RE experienced fewer major complications than those treated with VATE. More critically, RE was associated with a higher likelihood of achieving margin-negative resections and an increased count of harvested lymph nodes—two factors that are known to correlate with a more favorable prognosis [ 30 , 31 , 32 , 33 ]. Taken together, these findings suggest that RE not only potentially eases postoperative recovery, but also contributes to superior oncological outcomes.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Predictors of Textbook Outcome after Minimally Invasive Esophagectomy for Cancer: A Two-Center Study

Tagkalos,

Grimminger,

Gao

et al. 2024

Cancers

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Purpose: The textbook outcome (TBO), a multidimensional indicator that reflects an optimal perioperative course, has emerged as a significant prognostic variable in surgical oncology. Our study aimed to assess the occurrence and determinants of TBO following minimally invasive esophagectomy (MIE) for cancer. Methods: A total of 945 patients who had undergone MIE at two high-volume centers between 2008 and 2022 were analyzed. Multivariable logistic regression analysis was applied to identify the independent predictors of TBO. The potential selection bias associated with choosing between different MIE techniques—namely, robotic esophagectomy (RE) and video-assisted thoracoscopic esophagectomy (VATE)—was addressed by applying inverse probability of treatment weighting (IPTW). Results: TBO was realized in 46.6% of cases (n = 440), correlating with markedly better overall and disease-free survival. Multivariable analysis showed that treatment with RE (odds ratio (OR) = 1.527; 95% confidence interval (CI) = 1.149–2.028) was associated with a higher likelihood of achieving TBO, whereas a Charlson Comorbidity Index (CCI) of 2 or higher showed an opposite association (CCI2: OR = 0.687, 95% CI = 0.483–0.977; CCI ≥ 3: OR = 0.604, 95% CI = 0.399–0.915). The advantage of RE in attaining a higher rate of TBO, compared to VATE, remained statistically significant after applying IPTW, with rates of 53.3% for RE and 42.2% for VATE. Notably, RE contributed to a greater probability of thorough lymph node dissection, resection with negative margins, and the avoidance of major complications. Conclusion: TBO was realized in 46.6% of the patients who underwent MIE for cancer. Patients with a lower CCI and those who received RE were more likely to achieve TBO.

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“…The lack of a signi cant difference in local recurrence may be attributed to our dissection of more lymph nodes compared to other studies 16 . Increased lymph node dissection not only aids in determining the pathological stage but also decreases the likelihood of local recurrence 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Neoadjuvant Chemoimmunotherapy and Neoadjuvant Chemotherapy for Resectable Esophageal Squamous Cell Carcinoma: A Retrospective Study with 3-Year Survival Analysis

Wang,

Chen,

Lei

et al. 2024

Preprint

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Background Neoadjuvant chemoimmunotherapy (nCIT) for locally advanced esophageal squamous cell cancer (ESCC) has shown short-term benefits, but long-term survival outcomes are unclear. This study compares nCIT and neoadjuvant chemotherapy (nCT) in resectable ESCC. Patients and Methods: A retrospective analysis was conducted on ESCC patients who underwent nCT or nCIT followed by esophagectomy. Propensity score matching (PSM) with a caliper of 0.02 was employed to minimize bias. The primary endpoints included disease-free survival (DFS) and overall survival (OS). Results A total of 131 comparable pairs of ESCC patients receiving nCT and nCIT were selected for the final analysis. The nCIT had higher rates of pathological complete response (pCR) and major pathological response (mPR) compared to nCT. Additionally, nCIT led to significant tumor down-staging, higher rates of R0 resection, and increased lymph node clearance during surgery. Patients who received nCIT exhibited improved disease-free survival (DFS) and overall survival (OS) at the 3-year follow-up. The incidence of distant and mixed relapses was lower in the nCIT group compared to the nCT group. However, the risk of locoregional relapse was comparable between the two groups. Subgroup analyses showed that the benefits of nCIT were generally observed across most patient subgroups. Interestingly, in patients without pCR or mPR, nCIT still demonstrated better survival benefits than nCT. Conclusion nCIT demonstrated superior pathological response rates and improved 3-year DFS and OS compared to nCT alone in locally advanced ESCC, but long-term survival validation is needed.

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Impact of increasing lymph node yield on staging, morbidity and survival after esophagectomy for esophageal adenocarcinoma

Cited by 9 publications

References 35 publications

Recurrence and Survival After Minimally Invasive and Open Esophagectomy for Esophageal Cancer

Recurrence and Survival After Minimally Invasive and Open Esophagectomy for Esophageal Cancer

Incidence and Predictors of Textbook Outcome after Minimally Invasive Esophagectomy for Cancer: A Two-Center Study

Comparison of Neoadjuvant Chemoimmunotherapy and Neoadjuvant Chemotherapy for Resectable Esophageal Squamous Cell Carcinoma: A Retrospective Study with 3-Year Survival Analysis

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