Three-Field Lymphadenectomy for Carcinoma of the Esophagus and Gastroesophageal Junction in 174 R0 Resections: Impact on Staging, Disease-Free Survival, and Outcome

Abstract

Esophagectomy with 3-field lymph node dissection can be performed with low mortality and acceptable morbidity. The prevalence of involved cervical nodes is high, regardless of the type and location of tumor resulting in a change of final staging specifically related to the cervical field in 12% of this series. Overall 5-year and disease-free survival after R0 resection of 41.9% and 46.3%, respectively, may indicate a real survival benefit. A 5-year survival of 27.2% in patients with positive cervical nodes in middle third carcinomas indicates that these nodes should be considered as regional (N1) rather than distant metastasis (M1b) in middle third carcinomas. These patients seem to benefit from a 3-field lymphadenectomy. The role of 3-field lymphadenectomy in distal third adenocarcinoma remains investigational.

Association of GSTP1 Polymorphism and Survival for Esophageal Cancer

“…We evaluated the results of patients with varied cellular type, because previous clinical studies have shown a similar clinical outcome and tumor behavior in the different cellular types of esophageal cancer (41,42). We could also find a similar trend of survival for GSTP1 polymorphism in the patients of esophageal squamous cell carcinoma.…”

Lymph node metastases and prognosis in oesophageal carcinoma – A systematic review

“…Lymph node metastases occur rapidly and extensively involving both the regional and systemic lymph nodes via the thoracic duct [54,79]. Studies have shown that up to 35% of T1b tumours and 78-85% of T3 tumours have lymph node metastases [11,18].…”

“…However, several authors have criticised the TNM oesophageal staging system, claiming that it poorly stratifies what is a heterogeneous group of patients who have variable prognostic outcomes and undergo different treatment regimens [12][13][14][15][16][17][18][19][20][21][22][23]. The UICC has responded to these recommendations in its seventh edition of TNM staging, released in 2010, by modifying all three aspects of the scoring system.…”

Terapêutica neo-adjuvante aumenta as complicações pós-operatórias da esofagectomia?

“…Em resposta às recidivas loco-regionais que continuavam ocorrendo nos pacientes submetidos às ressecções esofágicas anteriormente descritas foram propostas operações com linfadenectomias ampliadas, ou seja, esofagectomias com linfadenectomia em três campos (abdominal, mediastinal e cervical) 12,33 ou linfadenectomias mediastinais radicais (linfonodos e demais estruturas do mediastino posterior) na busca de diminuir as recidivas neoplásicas e elevar a taxa de sobrevida 29,32 .…”