Optimum lymphadenectomy for esophageal cancer

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

Research output: Contribution to journalArticle

238 Citations (Scopus)

Abstract

OBJECTIVE: Using Worldwide Esophageal Cancer Collaboration data, we sought to (1) characterize the relationship between survival and extent of lymphadenectomy, and (2) from this, define optimum lymphadenectomy. SUMMARY BACKGROUND DATA: What constitutes optimum lymphadenectomy to maximize survival is controversial because of variable goals, analytic methodology, and generalizability of the underpinning data. METHODS: A total of 4627 patients who had esophagectomy alone for esophageal cancer were identified from the Worldwide Esophageal Cancer Collaboration database. Patient-specific risk-adjusted survival was estimated using random survival forests. Risk-adjusted 5-year survival was averaged for each number of lymph nodes resected and its relation to cancer characteristics explored. Optimum number of nodes that should be resected to maximize 5-year survival was determined by random forest multivariable regression. RESULTS: For pN0M0 moderately and poorly differentiated cancers, and all node-positive (pN+) cancers, 5-year survival improved with increasing extent of lymphadenectomy. In pN0M0 cancers, no optimum lymphadenectomy was defined for pTis; optimum lymphadenectomy was 10 to 12 nodes for pT1, 15 to 22 for pT2, and 31 to 42 for pT3/T4, depending on histopathologic cell type. In pN+M0 cancers and 1 to 6 nodes positive, optimum lymphadenectomy was 10 for pT1, 15 for pT2, and 29 to 50 for pT3/T4. CONCLUSIONS: Greater extent of lymphadenectomy was associated with increased survival for all patients with esophageal cancer except at the extremes (TisN0M0 and ≥7 regional lymph nodes positive for cancer) and well-differentiated pN0M0 cancer. Maximum 5-year survival is modulated by T classification: resecting 10 nodes for pT1, 20 for pT2, and ≥30 for pT3/T4 is recommended.

Original languageEnglish
Pages (from-to)46-50
Number of pages5
JournalAnnals of Surgery
Volume251
Issue number1
DOIs
StatePublished - Jan 2010

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Esophageal Neoplasms
Lymph Node Excision
Survival
Neoplasms
Lymph Nodes
Esophagectomy
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Rizk, N. P., Ishwaran, H., Rice, T. W., Chen, L. Q., Schipper, P. H., Kesler, K., ... Blackstone, E. H. (2010). Optimum lymphadenectomy for esophageal cancer. Annals of Surgery, 251(1), 46-50. https://doi.org/10.1097/SLA.0b013e3181b2f6ee

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

In: Annals of Surgery, Vol. 251, No. 1, 01.2010, p. 46-50.

Research output: Contribution to journalArticle

Rizk, NP, Ishwaran, H, Rice, TW, Chen, LQ, Schipper, PH, Kesler, K, Law, S, Lerut, TEMR, Reed, CE, Salo, JA, Scott, WJ, Hofstetter, WL, Watson, TJ, Allen, MS, Rusch, VW & Blackstone, EH 2010, 'Optimum lymphadenectomy for esophageal cancer', Annals of Surgery, vol. 251, no. 1, pp. 46-50. https://doi.org/10.1097/SLA.0b013e3181b2f6ee
Rizk NP, Ishwaran H, Rice TW, Chen LQ, Schipper PH, Kesler K et al. Optimum lymphadenectomy for esophageal cancer. Annals of Surgery. 2010 Jan;251(1):46-50. https://doi.org/10.1097/SLA.0b013e3181b2f6ee
Rizk, Nabil P. ; Ishwaran, Hemant ; Rice, Thomas W. ; Chen, Long Qi ; Schipper, Paul H. ; Kesler, Kenneth ; Law, Simon ; Lerut, Toni E M R ; Reed, Carolyn E. ; Salo, Jarmo A. ; Scott, Walter J. ; Hofstetter, Wayne L. ; Watson, Thomas J. ; Allen, Mark S. ; Rusch, Valerie W. ; Blackstone, Eugene H. / Optimum lymphadenectomy for esophageal cancer. In: Annals of Surgery. 2010 ; Vol. 251, No. 1. pp. 46-50.
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AU - Rizk, Nabil P.

AU - Ishwaran, Hemant

AU - Rice, Thomas W.

AU - Chen, Long Qi

AU - Schipper, Paul H.

AU - Kesler, Kenneth

AU - Law, Simon

AU - Lerut, Toni E M R

AU - Reed, Carolyn E.

AU - Salo, Jarmo A.

AU - Scott, Walter J.

AU - Hofstetter, Wayne L.

AU - Watson, Thomas J.

AU - Allen, Mark S.

AU - Rusch, Valerie W.

AU - Blackstone, Eugene H.

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