Optimum Lymphadenectomy for Esophageal Cancer

Rizk, Nabil P.; Ishwaran, Hemant; Rice, Thomas W.; Chen, Long Qi; Schipper, Paul H.; Kesler, Kenneth A.; Law, Simon; Lerut, Toni; Reed, Carolyn E.; Salo, Jarmo A.; Scott, Walter J.; Hofstetter, Wayne L.; Watson, Thomas J.; Allen, Mark S.; Rusch, Valerie W.; Blackstone, Eugene H.

doi:10.1097/sla.0b013e3181b2f6ee

Cited by 407 publications

(281 citation statements)

References 18 publications

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“…A study with 2,303 patients from 9 international centers showed that the number of removed lymph nodes was an independent predictor of survival, and to maximize this benefit a minimum of 23 lymph nodes should be removed (55). Another study with 4,627 patients from leading international esophageal cancer centers showed the same results: improved survival rates following more extensive lymphadenectomy (17).…”

Section: Relation Of Lymphadenectomy and Survivalsupporting

confidence: 59%

“…There are authors who claim that the extent of lymphadenectomy should be associated with the stage of the tumor. Rizk et al recommended for pT1 to resect 10 lymph nodes, for pT2 20 lymph nodes and for pT3-4 at least 30 lymph nodes (17).…”

Section: Number Of Lymph Nodes To Be Resectedmentioning

confidence: 99%

“…The surgical strategy should depend on the distribution pattern of nodal metastases but there is no worldwide consensus on the extent of lymphadenectomy. Lack of knowledge of the distribution pattern of nodal metastases in patients with esophageal carcinoma makes this disease unpredictable, and the optimal extent of the lymphadenectomy is still under debate (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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The extent of lymphadenectomy in esophageal resection for cancer should be standardized

et al. 2017

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The incidence of esophageal cancer increases, with approximately 482,000 patients diagnosed with esophageal cancer each year. Despite the growing incidence of esophageal carcinoma, the extent of the lymphadenectomy is still under discussion. Lymph node status is an important prognostic parameter in esophageal cancer and an independent predictor of survival. Surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy differs worldwide. For squamous cell cancer, Japanese surgeons have standardized the 2-or 3-field lymphadenectomy according to the location of the tumor. For adenocarcinoma, in the Western World accounting for 85% of all esophageal cancers, the type of lymphadenectomy to perform is not clear. Moreover, the use of neoadjuvant therapy may influence the mediastinal lymph nodes and the significance of the lymphadenectomy for survival. These aspects have challenged the traditional policy concerning lymphadenectomy, at least in the Western World. Furthermore, an extensive lymphadenectomy may improve survival but, on the other hand, may cause significant more morbidity. An overview of the literature on the extent of lymphadenectomy for esophageal cancer with respect to the supposed lymph node distribution patterns for squamous cell carcinoma and adenocarcinoma, the different lymph node classification systems, the commonly used surgical techniques and outcomes, and the proposal of observational cohort study to standardize the type of lymphadenectomy according to the type of tumor, location and use of neoadjuvant therapy will be provided.

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Section: Relation Of Lymphadenectomy and Survivalsupporting

confidence: 59%

Section: Number Of Lymph Nodes To Be Resectedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The extent of lymphadenectomy in esophageal resection for cancer should be standardized

et al. 2017

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“…Stilidi and Lerut (Stilidi et al, 2003;Lerut et al, 2004) demonstrated that an extended two-field or three-field lymphadenectomy could provide a higher rate of radical resection and improve the survival of esophageal SCC. Furthermore, based on the Worldwide Esophageal Cancer Collaboration data (Rizk et al, 2010), it was found that more extensive lymphadenectomy was associated with an improved survival in patients with esophageal cancer. Therefore, radical esophagectomy with extended lymph node dissection should be recommended to improve the prognosis of BSCCE.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Basaloid Squamous Cell Carcinoma of the Esophagus: A Retrospective Analysis of 142 Cases

Zhang¹,

Cheng²,

Xue³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Growing evidence supports improved survival after esophagectomy with increased extent of lymphadenectomy (11). The robotic platform may allow for greater facility in lymphadenectomy to surgeons adopting minimally invasive approaches to esophagectomy, as nicely illustrated by the current cased study.…”

Section: Meticulous Attention To Clear Identification Of Vital Anatomymentioning

confidence: 86%

Robotic assisted minimally invasive esophagectomy for esophageal cancer: a Comment on the Ruijin hospital experience

Pennywell

Sarkaria

2017

J. Thorac. Dis.

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Zhang et al. have described their technical approach to a total laparoscopic and thoracoscopic robotic assisted minimally invasive esophagectomy (RAMIE) via an Ivor Lewis approach for an early stage, distal, esophageal squamous cell carcinoma (1). The authors have offered a nicely detailed written, graphical, and pictorial description of port placement, positioning, and technical execution of the abdominal and thoracic portions of the operation using a three robotic-arm approach for both phases. The thoracic portion of the operation utilizes a semi-prone approach, and the intra-thoracic anastomosis is created using an end to end anastomotic (EEA) stapler. The authors depict several technical aspects including intra-corporeal creation of the gastric conduit, ligation of the thoracic duct, as well as dissection of lymph nodes along both recurrent laryngeal nerves. The patient did well with no immediate post-operative complications, and was discharged on post-operative day 8.The current report is representative of a growing number of institutional series of Ivor Lewis RAMIE for esophageal cancer (2-4). Non-robotic minimally invasive esophagectomy (MIE) has largely been established as an approach with decreased pulmonary and wound complications, and equivalent oncologic outcomes compared to open operations (5,6).While still limited in number, larger series of RAMIE are demonstrating feasibility, safety, and equivalence in early oncologic outcomes compared to other Ivor Lewis approaches (7,8). Putative advantages of the robotic approach include the advanced magnified stereo-optics, stabile and central visualization of the operative field, articulated instrumentation, and ability of the surgeon to self-assist. These advantages can be distilled into a single overarching principle: the surgeon simply gains far more control over the conduct of the operation. Intuitively, this suggests the ability to greatly increase operative efficiency with experienced users of current robotic platforms. These technologies may also potentially allow wider adoption of minimally invasive approaches by surgeons less experienced in standard minimally invasive techniques. However, this hypothesis, often assumed, is yet to be substantiated by evidence based studies.Several cautions and potential pitfalls regarding the RAMIE approach should be considered, especially when instituting new programs. Esophagectomy remains a complex operation, with operative principles and surgeon expertise that remain paramount to gaining acceptable outcomes, regardless of the approach. It is imperative for new programs early in the learning curve for overall RAMIE and/or robotic skill sets to be aware of these challenges, and to avoid recapitulating known and avoidable complications of these operations. First and foremost is the potential for airway injury and subsequent formation of enteric-airway fistula formation. This complication, far more common in minimally invasive operations (RAMIE or MIE), is almost always technical in nature. By and large, these devast...

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Optimum Lymphadenectomy for Esophageal Cancer

Cited by 407 publications

References 18 publications

The extent of lymphadenectomy in esophageal resection for cancer should be standardized

The extent of lymphadenectomy in esophageal resection for cancer should be standardized

Clinical Outcomes of Basaloid Squamous Cell Carcinoma of the Esophagus: A Retrospective Analysis of 142 Cases

Robotic assisted minimally invasive esophagectomy for esophageal cancer: a Comment on the Ruijin hospital experience

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