Positive peritruncal nodes for esophageal carcinoma. not always a dismal prognosis.
OBJECTIVE
For esophageal carcinoma, positive truncal nodes are considered distant metastases, and might be a contraindication for potentially curative surgery. With the development of new diagnostic tools more/smaller peritruncal nodes may be found positive preoperatively. We evaluate whether it is justified to exclude all patients with positive peri-truncal nodes from curative surgery.


METHODS
Retrospective study of all patients undergoing transhiatal resection for a mid-/distal esophageal carcinoma between 1993 and 1997.


RESULTS
110 patients underwent transhiatal resection for esophageal carcinoma. Sixteen patients had tumor-positive, resectable peritruncal lymph nodes not identified preoperatively, changing preoperative stage III into postoperative stage IV (M1a). After follow-up of 2.9 years (0.07-7.6), 49 patients (45%) were alive. On multivariate analysis radicality and lymph node status were independent prognostic factors. There was no significant difference in survival between stage III and stage IV (M1a) tumors: 1.7 and 1.5 years, respectively (p = 0.87). At the end of follow-up, 4/16 patients (25%) with stage IV (M1a) disease were alive without evidence of disease.


CONCLUSIONS
The presence of malignant cells in small, resectable peritruncal nodes does not preclude long-term survival. The results of new diagnostic modalities should be interpreted cautiously, until firm criteria for irresectability/incurability of positive truncal nodes are established.
Hulscher
J B
JB
Department of Surgery, Academic Medical Center/University of Amsterdam, The Netherlands. J.B.Hulscer@amc.uva.nl
Buskens
C J
CJ
Bergman
J J
JJ
Fockens
P
P
Van Lanschot
J J
JJ
Obertop
H
H
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis