Lymph Node Harvest During Esophagectomy Is Not Influenced by Use of Neoadjuvant Therapy or Clinical Disease Stage

Luna, Renato A.; Dolan, James P.; Diggs, Brian S.; Bronson, Nathan W.; Sheppard, Brett C.; Schipper, Paul H.; Tieu, Brandon H.; Feeney, Benjamin T.; Gatter, Ken; Vaccaro, Gina M.; Thomas, Charles R.; Hunter, John G.

doi:10.1007/s11605-015-2821-4

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…A register-based study from the United States on patients undergoing oesophagectomy for gastroesophageal cancers (n = 18,777) suggested that neoadjuvant therapy was associated with a decreased likelihood of obtaining 15 or more nodes, but did not assess specific numbers of nodes 37 . Another register-based study from the United States (n = 5,805), a Taiwanese register-based study (n = 2,151), and a hospital-based study (n = 111) from the United States found no association between neoadjuvant therapy and lymph node yield in oesophageal cancer 14 , 15 , 38 , but none of these studies adjusted the results for surgeon volume, or other potential confounders.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant therapy in relation to lymphadenectomy and resection margins during surgery for oesophageal cancer

Kauppila

Wahlin

Lagergren

et al. 2018

Sci Rep

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Differences in lymph node yield and tumour-involved resection margins comparing neoadjuvant therapy plus surgery with surgery alone for oesophageal cancer are unclear. Patients who underwent oesophageal cancer surgery in Sweden in 1987–2010 were included. Patients treated with neoadjuvant therapy were compared with those who underwent surgery alone. Outcomes were the number of examined lymph nodes (main outcome), number metastatic lymph nodes, and resection margin status. Rate ratios (RRs) and 95% CIs of lymph node yield were calculated by Poisson regression, and odds ratios (ORs) and 95% CIs of resection margin status by multivariable logistic regression, both adjusted for confounders. Among 1818 patients, 587 (32%) had received neoadjuvant therapy and 1231 (68%) had not. Lymph node yield was lower in the neoadjuvant therapy group (median 6 versus 8; adjusted RR 0.75, 0.73–0.78). Fewer metastatic nodes were identified following neoadjuvant therapy (median 0 versus 1; adjusted RR 0.76, 0.69–0.84). Neoadjuvant therapy associated to decreased risk of tumour-involved resection margins when adjusted for confounders except T-stage (OR 0.52, 0.38–0.70), but the association did not remain after adjustment for T-stage (OR 0.91, 0.64–1.29). Neoadjuvant therapy seems to decrease the lymph node yield and decrease the risk of tumour-involved resection margins by shrinking primary tumour.

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant therapy in relation to lymphadenectomy and resection margins during surgery for oesophageal cancer

Kauppila

Wahlin

Lagergren

et al. 2018

Sci Rep

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“…The randomized CROSS trial also found that the number of RLNs in patients with EC was significantly decreased after nCRT (18 vs.14, P < 0.001) [5]. However, a study by Luna et al [16] showed that nCRT did not affect the number of RLNs (16.0 vs 15.5, P = 0.57). The current study also did not find that preoperative radiotherapy affected the number of RLNs.…”

Section: Discussionmentioning

confidence: 99%

Impact of the number of resected lymph nodes on survival after preoperative radiotherapy for esophageal cancer

Zhao-qiang

Liu

et al. 2016

Oncotarget

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To assess the impact of the number of resected lymph nodes (RLNs) for survival in esophageal cancer (EC) patients treated with preoperative radiotherapy and cancer-directed surgery. The Surveillance Epidemiology and End Results (SEER) database was queried to identify EC patients treated from 1988 to 2012 who had complete data on the number of positive lymph nodes and number of RLNs. Kaplan–Meier survival analysis and Cox regression proportional hazard methods were used to determine factors that significantly impact cause-specific survival (CSS) and overall survival (OS). There were a total of 3,159 patients who received preoperative radiotherapy and cancer-directed surgery. The median number of RLNs was 10 in both patients who received and did not receive preoperative radiotherapy (P = 0.332). Cox regression univariate and multivariate analysis showed that RLN count was a significant prognostic factor for CSS and OS. Patients with 11–71 RLNs had better CSS (hazard ratio [HR] = 0.694, 95% confidence interval [CI]: 0.603–0.799, P < 0.001) and OS (HR = 0.724, 95% CI: 0.636–0.824, P < 0.001) than patients with 1–10 RLNs. The 5-year CSS rates were 39.1% and 44.8% in patients with 1–10 RLNs and 11–71 RLNs, respectively (P < 0.001). The 5-year OS rates were 33.7% and 39.9% in patients with 1–10 RLNs and 11–71 RLNs, respectively (P < 0.001). A higher number of RLNs was associated with better survival by tumor stage and nodal stage (all P < 0.05). RLN count is an independent prognostic factor in EC patients who undergo preoperative radiotherapy and cancer-directed surgery.

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“…2,92,93 In contrast to rectal carcinoma, the lymph node harvest in an esophagectomy specimen does not appear to be significantly affected by neoadjuvant therapy. 71,94,95 However, the frequency of lymph node metastasis is reduced after neoadjuvant therapy. 83,95 In addition, the distribution of positive lymph nodes may be altered by neoadjuvant therapy with one report finding fewer paracardial lymph node metastases compared with patients treated with surgery alone.…”

Section: Handling Of Treated Esophageal and Esophagogastric Junction mentioning

confidence: 99%

Pathologic assessment of gastrointestinal tract and pancreatic carcinoma after neoadjuvant therapy

Pai

2018

Modern Pathology

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Neoadjuvant therapy is increasingly used to treat patients with a wide variety of malignancies. Histologic evaluation of treated specimens provides important prognostic information and may guide subsequent chemotherapy. Neoadjuvant therapy is commonly employed in the treatment of locally advanced rectal adenocarcinoma, hepatic colorectal metastases, esophageal/esophagogastric junction carcinoma, and pancreatic ductal adenocarcinoma. Numerous tumor regression schemes have been used in these tumors and standardized approaches to evaluate these specimens are needed. In this review, the various tumor regression scoring systems that have been used in these organs are described and their associations with clinical outcomes are discussed. Recommendations regarding how to handle and report the histologic findings in these resections specimens are provided.

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Lymph Node Harvest During Esophagectomy Is Not Influenced by Use of Neoadjuvant Therapy or Clinical Disease Stage

Abstract: The LNH was not significantly influenced by neoadjuvant treatment or pathologic response. The LNR was inversely related to pathologic response after neoadjuvant therapy. Complete pathologic response to neoadjuvant therapy trends to improve survival rates.

Cited by 5 publications

References 25 publications

Neoadjuvant therapy in relation to lymphadenectomy and resection margins during surgery for oesophageal cancer

Neoadjuvant therapy in relation to lymphadenectomy and resection margins during surgery for oesophageal cancer

Impact of the number of resected lymph nodes on survival after preoperative radiotherapy for esophageal cancer

Pathologic assessment of gastrointestinal tract and pancreatic carcinoma after neoadjuvant therapy

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