The extent and number of metastatic lymph nodes limit the efficacy of lymphadenectomy in patients with oesophageal carcinoma

Yano, Koichi; Okamura, Tomonori; Yoshida, Yasunori; Ezaki, Takahiro; Yasumoto, Keiichi

doi:10.1016/0960-7404(94)90048-5

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…Similar to other reports, the most important finding of our analysis indicates that the number of metastatic lymph nodes (≥4) was a better predictor of poor survival than the presence of metastatic celiac nodes 9,13,29,30,32–34 . Specifically, Clark et al.…”

Section: Discussionsupporting

confidence: 90%

“…Furthermore, Shim et al 14 Similar to other reports, the most important finding of our analysis indicates that the number of metastatic lymph nodes (Ն4) was a better predictor of poor survival than the presence of metastatic celiac nodes. 9,13,29,30,[32][33][34] Specifically, Clark et al 13 reported that patients with four or fewer involved lymph nodes had improved survival compared with those with more than four involved nodes (24-month survival 78% versus 34%; P < 0.05) and that the presence of celiac node metastases was not predictive of outcome (P = 0.30). Similarly, Rice et al 9 reported that survival was decreased for patients with more than four positive nodes (hazard ratio, 1.35; 95% confidence interval, 1.07-1.71; P < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

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The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic

Schomas¹,

Quevedo²,

Donahue³

et al. 2010

Diseases of the Esophagus

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The management of esophageal cancer with involvement of celiac lymph nodes is controversial. The purpose of this retrospective study was to evaluate the clinical importance of metastases to celiac lymph nodes in patients with carcinoma of the distal esophagus or gastroesophageal junction (GEJ) who undergo surgical treatment with curative intent. We reviewed the medical records of 310 patients who underwent definitive esophagectomy at the Mayo Clinic, Rochester, Minnesota, between 1976 and 1999 for carcinoma of the distal esophagus or GEJ. The disease location was distal esophagus in 163 and GEJ in 147. Fifty-two patients (17%) were found to have celiac node involvement. The survival of these patients was compared with that of 97 N0 patients and 161 N1 patients without celiac node involvement. Squamous cell carcinoma and adenocarcinomas were found in 24% and 76%, respectively. Ivor Lewis esophagectomy was the most common surgical procedure (76%), followed by transhiatal resection (14%) and modified Ivor Lewis procedure (5%). The median number of nodes resected was 15 (range, 2-45). The median survival of the entire group was 18.8 months. The median survival was 48 months (range, 1.6 months-22 years) for N0 patients and 15.9 months (range, 0.03 months-14.4 years) for N1 patients without celiac node disease (P < 0.001). The median survival was 11.7 months (range, 2.2 months-15.7 years) for celiac node-positive patients, and this difference was statistically significant when compared with survival in N0 patients (P= 0.001) but not when compared with that in N1 patients without celiac node disease (P= 0.57). Survival at 3 and 5 years was 61% and 45% for N0 patients, 21% and 9% for N1 patients without celiac node disease, and 18% and 11% for patients with celiac node disease, respectively. At 10 years, 7% of patients with celiac node involvement in their resected specimen were alive. By multivariate analysis, patients with 4 or more positive lymph nodes had the worst prognosis (risk ratio [RR], 2.63; 95% confidence interval [CI], 1.98-3.48), regardless of their location. We concluded that celiac node metastases were not an adverse prognostic indicator in patients with celiac node involvement compared with N1 patients without celiac node disease. Overall, the number of positive nodes, not their location, correlated best with survival. Although median survival was poor, a small number of patients with resected celiac node disease had long-term survival. Patients with undetected celiac node disease at the time of surgical resection who were subsequently found to have celiac node involvement appeared to have a prognosis similar to that of patients with stage III disease. Therefore, treatment with curative intent should be considered for fit patients with celiac node disease.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic

Schomas¹,

Quevedo²,

Donahue³

et al. 2010

Diseases of the Esophagus

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“…Nishimaki et al 25 showed that survival rates of patients with metastases to a single anatomical field were better than those with metastases to 2 fields, similar to another report. 26 Moreover, the number of patients who received adjuvant treatment was high (6 of 7 patients) compared with another study. 22 Therefore, although the number of patients is small in this study, those with a few metastatic nodes confined to a single ana- Cumulative survival curves of patients with pT1 and pT2 esophageal cancers according to combined T, N factor.…”

Section: Commentmentioning

confidence: 77%

Prognostic Factors in T1 and T2 Squamous Cell Carcinoma of the Thoracic Esophagus

Tachibana

Kinugasa²,

Dhar³

et al. 1999

Arch Surg

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Background: Prognostic indicators in patients with T2 tumor have not been fully understood. Objective: To clarify the clinicopathologic characteristics and long-term results of T1 and T2 squamous cell carcinomas of the thoracic esophagus. Design: Consecutive case series. Setting: Department of surgery in a university hospital. Patients: Of 234 patients with primary squamous cell carcinoma of the thoracic esophagus, 142 patients underwent esophagectomy with curative intent: 97 patients had pT1 and pT2 tumors. Interventions: Investigated were clinicopathologic characteristics of 65 of 97 patients with pT1 and pT2 tumors; excluded were 7 patients who died of postoperative complications and another 25 patients who died of causes other than esophageal cancer. Main Outcome Measures: Clinicopathologic characteristics and long-term results. Results: Pathologic tumor stages were pT1 N0 in 23 patients, pT1 N(+) in 7 patients, pT2 N0 in 15 patients, and pT2 N(+) in 20 patients. Fifty patients are alive and free of

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“…Well-known prognostic factors of survival are as follows: R0 resection, 40 stage category, 26,27,[41][42][43]49 tumor category, 27,37,42,43 and node category. 26,27,36,41 For the node category, the number of involved nodes clearly affects survival in the following categories: 0 or 1 vs 2 or more, 42 0 or 1 vs 2 to 7 vs 8 or more, 50 1 to 4 vs 5 or more, 30,37,41,51 and 1 to 7 vs 8 or more. 26 The metastatic lymph node ratio 52 (the ratio of invaded-removed lymph nodes) is also an independent prognostic indicator in patients with distant lymph node metastases.…”

Section: Five-year Overall Survival and Prognostic Factorsmentioning

confidence: 99%

Extended Esophagectomy With 3-Field Lymph Node Dissection for Esophageal Cancer

Tachibana

Kinugasa²,

Yoshimura³

et al. 2003

Arch Surg

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To review the surgical outcomes of extended esophagectomy with 3-field lymph node dissection (3FLND) for esophageal cancer.Data Sources: Only articles written in English and written after 1980 were selected from MEDLINE. The following terms were identified: 3FLND, extensive or extended lymph node dissection (lymphadenectomy), radical lymph node dissection, cervical lymph node dissection, and extended or radical esophagectomy in esophageal cancer.Study Selection: There were no exclusion criteria for published information relevant to the topic. The most representative articles were selected when there were several articles from the same institution. Case reports were excluded.Data Extraction: Twenty-six articles were finally col-lected from MEDLINE. Eleven articles were also selected from reference lists of the pertinent literature.Data Synthesis: The collected information was organized. Conclusions:The conclusions drawn from those articles showed that extended esophagectomy with 3FLND would be a safe procedure in experienced hands, with low morbidity and acceptable mortality rates. When strict patient selection criteria were maintained, this procedure reduced locoregional recurrence and improved longterm survival rates. Although the therapeutic value of 3FLND is unproved in a randomized trial, extended esophagectomy with 3FLND would be the treatment of choice in selected patients.

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The extent and number of metastatic lymph nodes limit the efficacy of lymphadenectomy in patients with oesophageal carcinoma

Cited by 7 publications

References 10 publications

The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic

The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic

Prognostic Factors in T1 and T2 Squamous Cell Carcinoma of the Thoracic Esophagus

Extended Esophagectomy With 3-Field Lymph Node Dissection for Esophageal Cancer

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