LAUSR

The aim of this study was to determine the impact of lymph node yield and location on prognosis in patients with esophageal cancer. Absolute lymph node yield has been used as a surrogate for the extent of lymphadenectomy for esophagectomy. Ensuring adequate lymphadenectomy requires adequate removal of nodes from surgical fields, thus knowledge of lymph node location is vital to establish the impact of a radical lymphadenectomy. Data from consecutive patients with potentially curable adenocarcinoma of the esophagus or gastro-esophageal junction were reviewed. Patients were treated with transthoracic esophagectomy and two-field lymphadenectomy. Outcomes according to lymph node yield were determined. In addition analysis was carried out based on the hypothesis that retained positive nodes would lead to disease recurrence. The prognosis of carrying out less radical lymphadenectomies was calculated according to three groups: Group 1- exclusion of proximal thoracic nodes, Group 2- a minimal abdominal lymphadenectomy and Group 3- a minimal abdominal and thoracic lymphadenectomy. 357 patients were included. Median survival was 78 months(CI 53-103 months). Absolute lymph node retrieval was not related to survival (p=0.920). An estimated additional four (2-6) cancer related deaths was projected if Group 1 nodes were omitted, 15 (11-19) additional deaths if Group 2 nodes omitted, and four (2-6) deaths if Group 3 nodes omitted. A minimal lymphadenectomy (Groups 1,2 and 3) was projected to lead to 19 (15-23) additional cancer related deaths. Extensive lymphadenectomy allows accurate staging. In patients who do not receive neoadjuvant chemotherapy it may confer a survival benefit. The absolute number of lymph nodes retrieved may not be a good surrogate for extent of lymphadenectomy and correlation with location is required.