Two‐ versus three‐field lymphadenectomy for esophageal cancer. A systematic review and meta‐analysis of early and late results

Datrino, Letícia Nogueira; Orlandini, Marina Feliciano; Serafim, Maria Carolina Andrade; Santos, Clara Lucato dos; Modesto, Victoria Andrade; Tavares, Guilherme; Tristão, Luca Schiliró; Bernardo, Wanderley Marques; Tustumi, Francisco

doi:10.1002/jso.26857

Cited by 7 publications

(3 citation statements)

References 45 publications

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“…Third, other than pathological findings, differences in patient backgrounds may be a confounding factor. Lastly, although three-field lymphadenectomy has been widely performed for upper and middle thoracic esophageal cancer in Japan ( 23 ), its validity is debatable ( 23 - 25 ), and the external validity of this study is limited when considering that local effects cannot be excluded by surgical intervention.…”

Section: Discussionmentioning

confidence: 98%

Equivalent prognosis with no lymph node metastasis to pathological complete remission in patients with localized advanced esophageal cancer after neoadjuvant triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by curative surgery: a single-center retrospective cohort study

Chinen,

Yamaguchi,

Ohzawa

et al. 2024

J Thorac Dis

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Background Adjuvant nivolumab therapy has become the standard therapy for patients with localized advanced esophageal cancer with non-pathological complete response after neoadjuvant chemoradiotherapy followed by curative surgery. However, the necessity of this therapy for patients after neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil (DCF) regimen followed by surgery is unclear, and the prognosis of grouping based on the presence or absence of pathological tumor and lymph node findings has not been analyzed. Therefore, our study aimed to address these questions. Methods This retrospective cohort study included patients with cT1N1–3M0 and cT2–3N0–3M0 esophageal cancer according to the Japanese Classification of Esophageal Cancer, 11th edition, who received NAC with DCF followed by curative surgery between 2008 and 2020 at Jichi Medical University Hospital. We divided patients with ypT0−3N0−3M0 into four histological groups, namely ypT0N0, ypT+N0, ypT0N+, and ypT+N+, and we evaluated overall survival as the primary outcome and the prognostic relationship of lymph node metastasis as the secondary outcome. Results A total of 101 patients were included in this study. Kaplan-Meier analysis showed that the curves of the ypT0N0 and ypT+N0 groups were almost identical, while they differed from the other two groups. The hazard ratio of ypN+ was 4.44 (95% confidence interval: 2.03–9.71; P<0.001). Conclusions The prognosis of the ypT+N0 group after NAC with DCF followed by surgery was similar to that of pathological complete remission. Grouping patients according to pathological lymph node status is a reasonable predictor of prognosis.

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Section: Discussionmentioning

confidence: 98%

Equivalent prognosis with no lymph node metastasis to pathological complete remission in patients with localized advanced esophageal cancer after neoadjuvant triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by curative surgery: a single-center retrospective cohort study

Chinen,

Yamaguchi,

Ohzawa

et al. 2024

J Thorac Dis

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“…It has been concluded that removing negative lymph nodes in secondary level lymph nodes will not improve disease control. On the other hand, a higher rate of intra- and postoperative complications have been observed after extended lymphadenectomy in different oncologic entities [ 13 , 14 , 15 ]. Based on such extrapolation from other entities, it seems appropriate to perform a systematic and careful lymphadenectomy in the primary nodes for proper staging and perform adjuvant therapies in case of any suspicion of microscopic systemic disease.…”

Section: Discussionmentioning

confidence: 99%

Lymph Node Staging in Perihilar Cholangiocarcinoma: The Key to the Big Picture

Rogacka,

Benkö,

Saner

et al. 2023

Current Oncology

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Klatskin tumors have a bad prognosis despite aggressive therapy. The role and extent of lymph node dissection during surgery is a matter of discussion. This retrospective study analyzes our current experience of surgical treatments in the last decade. Patients and Methods: A retrospective single-center analysis of patients (n = 317) who underwent surgical treatment for Klatskin tumors. Univariable and multivariable logistic regression and Cox proportional analysis were performed. The primary endpoint was to investigate the role of lymph node metastasis for patient survival after complete tumor resection. The secondary endpoint was the prediction of lymph node status and long-term survival from preoperatively available parameters. Results: In patients with negative resection margins, a negative lymph node status was the prognosis-determining factor with a 1-, 3-, and 5-year survival rate of 87.7%, 37%, and 26.4% compared with 69.5%, 13.9%, and 9.3% for lymph-node-positive patients, respectively. Multivariable logistic regression for complete resection and negative lymph node status demonstrated only Bismuth type 4 (p = 0.01) and tumor grading (p = 0.002) as independent predictors. In multivariate Cox regression analysis, independent predictors of survival after surgery were the preoperative bilirubin level (p = 0.03), intraoperative transfusion (p = 0.002), and tumor grading (G) (p = 0.001). Conclusion: Lymph node dissection is of utmost importance for adequate staging in patients undergoing surgery for perihilar cholangiocarcinoma. In spite of extensive surgery, long-term survival is clearly associated with the aggressiveness of the disease.

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“…Postoperative chylothorax is usually caused by injuries to the thoracic duct or to its tributaries during surgery [ 4 ] . Chylothorax may happen in several types of cardiothoracic surgery, including esophagectomy, lobectomy, cardiac procedures, and mediastinal tumors resection [ 5 , 6 , 7 , 8 , 9 ] . The diagnosis of chylothorax consists of evaluating triglyceride levels, cholesterol values, and microscopy crystals [ 10 ] .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis

Santos,

et al. 2023

Braz J Cardiovasc Surg

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Introduction Chylothorax after thoracic surgery is a severe complication with high morbidity and mortality rate of 0.10 (95% confidence interval [CI] 0.06 – 0.02). There is no agreement on whether nonoperative treatment or early reoperation should be the initial intervention. This systematic review and meta-analysis aimed to evaluate the outcomes of the conservative approach to treat chyle leakage after cardiothoracic surgeries. Methods A systematic review was conducted in PubMed®, Embase, Cochrane Library Central, and LILACS (Biblioteca Virtual em Saúde) databases; a manual search of references was also done. The inclusion criteria were patients who underwent cardiothoracic surgery, patients who received any nonoperative treatment ( e.g. , total parenteral nutrition, low-fat diet, medium chain triglycerides), and studies that evaluated chylothorax resolution, length of hospital stay, postoperative complications, infection, morbidity, and mortality. Central Message Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates. Results Twenty-two articles were selected. Pulmonary complications, infections, and arrhythmia were the most common complications after surgical procedures. The incidence of chylothorax in cardiothoracic surgery was 1.8% (95% CI 1.7 – 2%). The mean time of maintenance of the chest tube was 16.08 days (95% CI 12.54 – 19.63), and the length of hospital stay was 23.74 days (95% CI 16.08 – 31.42) in patients with chylothorax receiving nonoperative treatment. Among patients that received conservative treatment, the morbidity event was 0.40 (95% CI 0.23 – 0.59), and reoperation rate was 0.37 (95% CI 0.27 – 0.49). Mortality rate was 0.10 (95% CI 0.06 – 0.02). Conclusion Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates.

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Two‐ versus three‐field lymphadenectomy for esophageal cancer. A systematic review and meta‐analysis of early and late results

Cited by 7 publications

References 45 publications

Equivalent prognosis with no lymph node metastasis to pathological complete remission in patients with localized advanced esophageal cancer after neoadjuvant triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by curative surgery: a single-center retrospective cohort study

Equivalent prognosis with no lymph node metastasis to pathological complete remission in patients with localized advanced esophageal cancer after neoadjuvant triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by curative surgery: a single-center retrospective cohort study

Lymph Node Staging in Perihilar Cholangiocarcinoma: The Key to the Big Picture

Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis

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