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

Abstract

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.

Perioperative chemotherapy versus neoadjuvant chemoradiation for patients with adenocarcinoma of the distal esophagus in Austria: a retrospective analysis

“…The standard actual is a two-field lymph node dissection abdominal and thoracic according to the German guidelines, which was performed in all cases in this study. A recent study evaluating the relation of neoadjuvant therapy to lymphadenectomy suggested that after neoadjuvant therapy, the expected lymph node yield should be 25% lower, and 32% lower after neoadjuvant chemoradiotherapy than after surgery alone [27]. A significant difference in the number of resected lymph nodes between the two therapies could be found in the current study.…”

Feasibility, safety and oncological outcomes of minimally invasive oesophagectomy following neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma – Experience from a tertiary care centre

“…Further, the induction therapy with nCRT may have negatively affected the LNY, due to involution of nodes, as also reported in the literature. [ 10 34 35 36 ]…”

The Association of Textbook Outcome and Long-Term Survival After Esophagectomy for Esophageal Cancer

“…Neoadjuvant therapy was shown to be a predictor of a higher textbook outcome rate; the cause could be the positive effect of neoadjuvant therapy on the textbook outcome parameter "tumor negative resection margins." 2,16 Identifying patients at higher risk of not achieving textbook outcome on the basis of these predictors could result in increased awareness of a higher a priori chance for a complicated postoperative course that can aid in patient selection, treatment selection, and increased postoperative monitoring.…”